Patterson, Tim 84228C

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C�CAIMA ❑ DREDGE & FILL Nn 8'12,28 A B iZ D
GENERAL PERMIT Prevlous permit
❑ Modification ❑Complete Reissue [] Partial Reissue Date previous permit Issued
As authorized by the State of No h Carolina, Department of Environmental Quality and the Coas Resources Commission In an area of environmental concern pursuant to:
I SA NCAC� iTr Rules attached. General Permit Rules available at the following link: www.deq,nt.gov/CAMArules
Applicant Name Authorized Agent
Addres r, Project Location (County):
City tate ZIP dr Street Address/State Road/LDt #(s) _
Phone # ��+(���[sssL�i — /odd G� `7 " -7Pe
Email Subdivisloll
City ZIP
Affected CW EW PTA ES ❑ PTS Ad). Wtr. Body y✓1�.�,' `/ n an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA 0 PWS Closest Mal, Wtr. Body
OR : yes o PN yes no
Type of Project4 Activity_
Shoreline Length
Access Length '
Pier(dock)length
Fixed Platforms)
Floating Platform(s)
Finger pier(s) &. y
Total Platform area 1
Grain length/#
Bulkhead/ Riprap length�
Avg distance offshore
Breakwater/Sill I--
Max distance/ length
Basin, channel /" I
Cubic yards /r
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other i
SAV observed: yes no
Moratorium: n/a yes no
Site Photos:
Riparian Waiver Attached: A
no
A building permit/zoning permit mli Be re uirec
Permit Conditions _
Agent o Applicant P
14 3
I
ture —Please r Ida
Application Feels)
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* 1by
4 I
I
by:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
CRC RULES ANM&E NDITIONS THAT
statement on back of permit"
Check
AND REVIEWED COMPLIANCE SIREMENT. (Please Initial) let
01
Order Is uing D to &Irati& Date

AGENT AUTHORIZATION FOR CANIA PERMIT APPLICATION
Name of Property Owner Requesting Permit:.._._.e._t_l�'L1 f.��P�'5e
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
r-%WVV111 %-,UIIUCIS-LUE
to act on my behalf, for the purpose of applying for and obtaining all CAAMA permits
necessary for the following proposed development: �Wlrlceeneo ! (I
cK 6014" t1110C
at my property located at Z I`i I
in 1 `' , LI' County.
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application,
Property Owner Infom on:
Signature
Pri t or Type Name
Title
Date
This certification is valid through 1 1.

N,C. ENVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM,
CERTIFiED MAIL - RETURN RECEIPT REQUESTI<Q or HAND DELIVERY
(Top portion to be completed by owner or their agent')
Name of property owner
i\dOress of Pr^periy
Mailing Andress of Owner
Owners email ') j 1 k [ % j - - -= j- Owner's PhonHII: IL
r' gent-s Name:
Agent s Email
,
ADJACENT RIPARIAN PROPERTY OWNER'S G,-!RTlF1CATl0N
;Bottom portion to be corrjpleted_tav the Adlacer1t PrqR$rty Owner,
I hereby certtfy that 1 own property adjacent to the above referencw7 ^ ;ern ''he ;nd viduai applyir,e E,: r �r:s
permit has described to me, as shown on, the attached drawing, the development they arc orocos,no A
description or drawjno with dimensions, etust be aryvided }vi2ti this tr��apr
1 DO NOT have objections to this proposal. -- 1 DO have obey-tion?, tt: this pr;>pcsai
tf you have objections tv what is being frropvsed, you mint notify fhe N.C. t?Ivision of Gaastal
Management (DCM) in writing within 10 days of receipt of this notice, Correspondence should 6e
mailed to 400 Commerce Ave., Morehead City, NC 2W7. DCM representatives can also be contacted
at [phone]. No response is Considered the same as no objection if you have been notified by
Cert Pied Mail.
WAIVER SECTION
t understand that any proposed pies. d:,:: k, mooring plings. boat ramp breakwater, boar ;Dose. I,ft, ,r
groin must be set back a minimum dis',a-i..e of 15, from -my area of riparian, access unless waiver; by T:
(this does not apply to bulki^eads or nprap revetments. i. ; °f v0'J wisp' to waive the setback. ynJ rPYU�t slpil
the appropriate blank belov, i
l DO Nish to waive some/all of the 15' setba Qq
-OR-
�1111-
9idjacent Rioar!arr Prcr:a;Y 0 R,
1 do not wish to waive the 15' setback requirement (initial the blank)
Signatt;re of Adjacent Ripanan Pr>pe ,y Owner
TypedlPrinted name of ARPO: f°4, l2,U
Mailing Address of ARPO:CPO _ 'y —_.._ Q
ARPO's email: _----._ ARPO's Phoned-
Rater _ 'waiver is valid for up to one year from ARPO's Signature"

WC. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONWAIVER FORM
(Top portion to be cornpleted by owner or their agent)
Name of Properw Omer, 'I
I • -„# ` r. 3 €i
s €Ta 31 J ,,., ;tit Phont 1 (
ADJACENT RIPAMANIPROPEWrY OWNER'S CERTIFICA110N
i hetabyceififyihott tjwn prop t+ adjacetit tv- t}'.. abvve property ih'
permit has descflbed to n1e, as shown w the attaf,,hed draw4ig,the developme-rst. they, are foposlrig- i��
,Cqscdpt1p-n pr cirawinq,a,=4&h!q Upr 4 s r tit � st �,t t qtt r<
�� 1„ r Z f i c, r ti< r,
w n. , _ 4 . t t a 7,€at i i. t is t .. ,a)l _. w 0 hive �t�j�.clions �.�3 'il`si Mrs sal3
iff You have objections to what is bwng proposed, you must not y tho 6 T
ahagehle t (OCR) In wrifingwithin 10 days- Of reveiPf Of this notice. Con-0-spondance should be
ailed to 400,CommotveAva, Morehead City, NC 2 f,57> M, twesenteffives can also be ipontaci*d
t (7,52) 808-2808. No response is consWered the same as no objection If you have been not1fied by
#r a Mak
WAVVEIR SECTION
1 urleerst trd thin any prif,t ed pier, do$ ci<eriloi r3 —,g }�ijif1�3sbi&�l ramp, s'��?i::aia:�l�%t:3 i ���l�i,d��. 6i�e CiF
ioin nit. st �y e tit back a s 3ai`t€iTii, m diatta>ri{.e of Ew' froi d my $Fe4T vY rip =e s Uri,a' ss b�"al�ted by to
€i� u r � t {y tc is it<#s r rst r r i E i rt { (It ye �r V'Am i .� a iv "t tixti c a,i t . �
t�i appropriate tare bfpnk below.) p� �
i L v` 'ill to waive sunlehah of f 'i'`Setback
I not wis to ab` ive ilia 57x iel-bat � �'s �z�ire Silent �!-46'ai the ����s€*') �t
;,�ti�i"E�`ifg.S�? +rt Li]�34�i1� T1!l,}xl��tiil
feted riarne of ARM
fj 3 0 MOW* of
E !
" aliver Is validfor up. to onu yearfrom AR 's

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