Raymond, Mat 90008C

,o�°``°"�'�N EI CAMA ❑ DREDGE & FILL 90008 A B C D
a , GENERAL PERMIT Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State
Phone # (_ )
Email
Authorized Agent
Project Location (County):
ZIP Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing "
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
Ip
A building permit/zoning permit may be required by: �, l
Permit Conditions
r 7
(Scale: )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
211e
« '
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

0'0°1COASrAe&�❑CAMA ❑ DREDGE & FILL N° 90008 A B '. C.'- D
y = GENERAL PERM 1 T Previous permit
0 F I Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State A.) i,..- ZIP 5
Phone # (_ )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity C G I +
(Scale:
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) t'
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards —'
Boat ramp ='
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: r 'i je tY, T, zk C f
Phone Number:
Email Address:
I certify that I have authorized C3 Scott, Inc
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
f
in.. County,
l furthermore certify that 1 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 information:
Signatre
Print or Type Name
Title
Date
This certification is valid through 1 1

Initial
Here on
Line of ,
these
!inns
I n itial
Hereon
one of ,
these
lines
AC1Jf� if: IIPt1lA P U'tMI I Y CiWiVEI ST AT NiE�iT
I hereby certify that I own property adjacent to
property located at
(NaM6 of Pi•oporty Owner)
�' � ,,. ,
on
(A,ddross, Lot, B lock, Road, - etc.)
In C
,z N. C.
(Waterbody) (Ci ylT—ow n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatl�n.
"V'-'+� 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing ddtrdtdpment must nil ltr descrlp lon below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat rump, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 1 b` from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must Initial the appropriate blank below.)
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I do wish to waive the 15' setback requirement.
_„__ i do not wish to waive the 15' setback requirement.
(Property Owner Information)
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P40n or Type Neme
Mailing Address
Cltylstatelzip
Telephone Nut»ber/ email address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner information)
* t<
Signature*
Tuv., #1>-11.
Print or Type Name
w 17)4Ipl;;51
Malting Address
Citylstatelzip
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Telephone Number/emall address
Date*
(Revlsed Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at _ 1_0_ ;-) D"a L+
9
(Nam, Propefty Own�r) XIL
(Address, Lot, Block, Roach, etc.)
on
(Waterbody) (City/Town and/or County)
s
Initial The applicant has described to me, as shown below, the development proposed at the above
Meta on location.,-/-,
one of PI e� L"•� I have no objection to this proposal.
these I have objections to this proposal.
lines
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
Initial me. (If you wish to waive the setback, you must initial the appropriate blank below.)
Here on `) I do wish to waive the 15' setback requirement.
one of t+
these I do not wish to waive the 15' setback requirement.
lines
(Property Owner Information)
Star 1'G' - r
i u}a
Print or Type Name
Marling Address
city/state/Zip
€ r % J , (` I
Telephone Number/email address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Si nature* �
Print or Type Name'
Mailing Aldress
CrtytSfatel ip
3'!
Telephone Number/email address
.1 o_ I_ ..
Date*
(Revised Aug. 2014)