Lockard, Thomas - 91323C

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❑CAMA ❑ DREDGE & FILL N9 91323 A B ( D
GENERAL PERMIT Previous permit
Date previous permit issued —
❑ 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 n-J H, I % () // ❑ Rules attached. K General Permit Rules available at the following link: www.deamc.gov/CAMArules
Applicant Name I I I r, - h 105
Address 41, 11 k,,+l Of^��
City �>1p� i I,,,- ! State %. ZIP
Phone#(90 iY 9 — z�l1I)
Email IOC f( r.:vJ /i,cn,a( 64% urn/1W. Lo"I
Affected ❑ CW 0 EW PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Authorized Agent h i V(+'/I'I[ �r-„Sf �'^+f�O 1+ Z, Z,
Project Location (County): C ✓u ✓( r'
Street Address/State Road/Lot#(s) ��/� P, �'1 •,�7,+� i�oH�
Subdivision --"
City I -I 1 v[Jot Il
2.1 5 ;'
Adj. Wtr. Body /V i ' ),r. / , +� .q' (nat/man/unk)
Closest Maj. Wtr. Body /y C
.. 1 ,:.Ili ',t.'
(Scale:/(/-g )
Mr_
-?�__.—)L
1—
Access Length
Pier(dock)length S
-_--I
-
--
-
—
-�—
—
1
1
Fixed Platform(s)
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j)
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((r
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fl „
_
_ �
_ �
711
FloatingPlatforms �
()
I.
1—
Finger pier(s)T-
Total Platform area I UU s a �#
�_
Groin length/#
Bulkhead/ Riprap length
�
w
I-
—
__
—
� _...
._.
..
_L..
...
i.....
Avg distance offshore
Breakwater/Sill
-
i-
-
--T----
—j
—
-
Maxdistance/length
Basin, '-
channel
IL
i 7-
Cubic yards-
Boatram
Boathouse/ BoatliftAl
(t/
j
I
Beach Bulldozing
Other ---
-S
t,
J,_
SAV observed: yes
Moratorium: n/a
yesSite Photos: yes no
_..
_
! _
_
_
_
_
Riparian Waiver Attached: ,yesj no
A building permit/zoning permit may be required by: ��"<✓.'�
Permit Conditions
'
14 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 Feels) Check#/Money Order
Signaure )
f J V
Issuing Date Expiration Date

❑CAMA ❑ DREDGE & FILL N° 91323 A B cl D
Previous permit
GENERAL PERMIT
3 Date previous permit issued
ONew ❑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 , z ❑ Rules attached. 9 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
I
City , State i zip
Phone #
O •'
Authorized Agent (siVr� 1.� /ii r-.are (.,/�^'r• ^ / L�•
Project Location (County):L ✓✓,
Street Address/State Road/Lot#(s) Ii IS f:�l•„i:f,°I {�„J
Subdivision ""`-`
City ji✓ / I` zip
Affected ❑CW
E]EW ❑PTA
❑ES
❑PTS Adj. Wtr. Body /v (tat/man/unk)
AEC(s): ❑ IDEA
❑ IHA ❑ UW
❑ SPIMA
A/
❑ PWS Closest Maj. Wtr. Body /tr i i : f1 ✓/�%�
ORW: yes/no
PNA: yes/no
Type of Project/ Activity �
(Scale:/(/ r§ )
5"relina . nnMF
V-_
Access Length
Pier(dock)length
I
t
5
✓
—
Fixed Platform(s) i-
+
h
Floating Platform(s)-
I
r_
�L
-
-
✓-
-
-
I
-
-
-
Finger pier(s)
Total Platform area
-1-
-
-r
Groin length/k
Bulkhead/Riprap length''}-—
Avgdistanceoffshore--
Breakwater/Sill-
Max distance/length--
A.�
l
'+.'
l'tl✓
L
Basin, channel -
Cubicyards - `
Boat ramp
Boathouse/Boatlitt
!
I-_
) i. f
I
!
-
-
F-
—-
—
Beach Bulldozing -"
Other
SAV observed: yes no
!
i,
Moratorium: n/a yes
Site Photos: yes no
Riparian Waiver Attached: .yes no (_1
',
. u
._
A building permit/zoning permit may be required by:
Permit Conditions �TAR/PAM/NEUSE/BUFFER(circle one)
```--❑YYY 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)'
f
Agent or Applicant PRINTED Name _ Permit Officer's PRINTED Name
Signature**Please read compliance statement on back of permit" A Signatjure
Application Feels) Check N/Money Order Issuin Date E%piaEE�te

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AGENT AUTHORIZATION FOR CAMA PERMCr APPLICATION
Name of Property Owner Requesting Permit - iN\Oo Aa s "t) I—° f-�4-d.
Mailing Address W1
lt�l�sbv�a �C d�S3�
Phone Number,
Email Address: ly �o R-d Mop e yAv.ou, c e.�
I certify that I have authorized i 1yc2 eZ,�k
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: c �Yr w cca ss
at my property located at 1 b � 3�\� a �o �L S�Av e�a�k �� -)z
in ,C ?.evsd. County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Cokstal 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 Informatlon:
Signature
Print or Type Name
Title
5-1 /S lam
Date
This certification is valid through I I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: WhDY-LUS �J L-OGkGY
Address of Property: 4ILo -R NzxVelbCu KV ,
Mailing Address of Owner: -Run -PL GV04z n Ac- a%,3-4
Owner's email:locYtag�ioA&N a y.Sw. Ld .0wnersPhone#:(C(%q—5t\Lk
Agent's Name: �VPi/titri%iCdyrrt ��� i'C oi1Agent Phone#:gig —(YZ-721a
Agent's Email: �22/n (Q n Yel f cj7�/{jR/7 r/ e C�•jhS?�CU�io/1 CD ��!
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom porien to be completed by the Adjacent Property Owner
I hereby certify that 1 own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
14 ..AM1h..... w.....,........nw ..:_•--- --- ----' — " .. _ . ..
I DO NOT have objections to this proposal. I DO have objections to this proposal.
n you nave opjections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DOM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28567. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Cen"ad Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, twat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
100 wish to waive some/all of the 15' setbawZ !
-OR- _ v
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Ripanl
TypedlPrinted name of ARI
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
Date: 3 1 Y f L-, *waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. MomQ5 L-bCkctrd,
Address of Property: t�1 S �t✓� Qr1(� t Cl. 1�V ��OCk ni
Mailing Address of Owner. -Run -PL C1CAA.J ro N C a9534
Owner's email: ldcLt4&Avaa4> ,,t o/o, c� �ihvner s Phone#: Cq(Qt) ,�344 . 5 1 t -A
AgentsName:Rilk'! �GTy1/1�1)ECG/�51y�L 0�lAgentPhone#. 9/9 /1--c -%zl-?
Agents Email;
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
n you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28657. DCM representatives can also be contacted
at [phone]. No response Is considered the same as no objection If you have been notifted by
Certified Mail.
WAIVER SECTION
I understand that any proposed 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 me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback & � i/ -
-OR-
Signatu olAdjacent Riparian Property yOOwner'
/x`
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
TypedlPrinted name of ARPO:
/ Mailing Address of ARP.:
ARPO's email: /%7�Lrrrj�LO`(�2/J%%>'dkPO s Phone#: /�/ ��� ��/ ✓�n st
Data: ' ! • giver Is valid for up to one year from All Signature'
O Revised July 2021