78076A - Healy

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LJGENERAL PERMIT P. W.V—
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@(LAMA / ❑ DREDGE & FILL
NO 78076 Q B C D
GENERAL PERMIT
Previous permit#
VNew El Modification ❑Complete Reissue
El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality , / ^ /,
7-
and the Coastal Resources Commission in an area of environmental
concern pursuant to I SA NCAC
[wMales attached.
Ti Applicant Name wtk, d �a�.drr_ NG�.ty
1 IF��:we'
Project Location: County f.
Address GMR 4%3 C�o�c l� 75
Street Address/ State Road/ Lot #(s) 13,?, t3fcnrlirs, C+.
City Afo State R r zip -,
_iaj�_" �f
+49
Phone # (tom) -1717-3$3l l E-Mail 1 kft(Y I Q lt?
ig &,.,r- Subdivision S 5kC✓PS .P/VcS`G TiAXl
Authorized Agent NVci r IC.
City N �i _ ziP'Lqc?
JJP&
Affected ElCw LdEvf lYPTA dEs ❑PTS
Phone# ( ) River Basin Itt
AEC(s): I]OEA ❑HHF ❑IH ❑ UBA ❑ N/A
Adj. Wtr. Body CL J�.`i LL' mw /unkn)
['Inmet Moi wtr Rnriv _fort. tuc k _ Ci A _—
ORW: yes / to PNA yes / fio
------- "
-' - - " -
--
Type of Project/ Activity Q•pr
t:pirrTp
5-, for eaP4-1o�e4 pt,>•%C
/'J7-J, )
(Scale:
Pier (dock) length _
Tom_ -
r e
Fixed Platform(s)
Floating Platform(s)
r
X_
Finger pier(s)
V�`
Groff'• SeG
CLAr
Groin length
_
"`P P
t
number
\
Cn
Bulkhead/ "prop engthk'-
i��J
avgdistance offshore _� ��
_u ��
•
-�
max distance offshore
l• J
_�_
Basin, channel
N
cubic yards
�J,
-
o �'
17
Boat ramp
Boathouse/ Boatlift -
C`�
Beach Bulldozing
1
Other
_
_
Shoreline Length
J
SAV: not sure yes no
in
V
QV
l y
Moratorium: 0 yes no
Photos: © no
_ I �e I
P Ic-.'fed • �``f]
-
Waiver Attached: no-
i
A building permit may be required by: J OG+ti
/' V
G IaG,L�i.,
❑See note on back regarding River
Basin rules.
( Note Local Planning jurisdiction)
QVO
Notes/ Special Conditions I)R Pr
n
Ai Ll a+ a code H`;l c,;-
it
� boyo' 7�S ti(i"
1
3 Agbaie
Q� t,uC be, #o,,.+ecf a i 4+k a fff
INnik' Prty
Aghnt or Applicant Printed Name
X
Signature '"* Please read compliance statement on backof permit'**
sibs C0) ISI3
Application Feels) Check #
et be,
ermi[Officer's Pr' tact N —
Signature •� c
3—O —
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: TI M 0 TH `( P H E A Li
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
CMR 00 BOX 1175
Iv 1218 e ciroaiI co
Aq nt I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: U a r'7 1 to re Vet n? en t
at my property located at 13 2 B r d n Won C o u r-t" Dock, N C ,
in A a r e 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 Information:
/axe
Signature
i�mofhy P Healy
int or Type Narhe
Cwr7er
Title
02l 07 / 2021
Date
This certification is valid through 08 107 I 2021

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner.
zal
Address of Property: 13.2 e,-mdcr7 Coc7-� Dock, N-C. 2-7`747
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
My�
Rrry mortVte.
Mailing Address:
Agent'sphone#:
252- Zo2
e733
ki6'y HwwK,
N C,
21117
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 description or drawing. with dimensions, must be provided with this letter.
olrAb I have no objections to this proposal. I have objections to this proposal,
If you have objections to what Is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at_ r:n;'ivy_vay.ncc_cvstaImanactomanr.neVWo�/c_m�S-Yff !i-sti�x� or by calling 1-888-4RCOAST.
No response Is considered fhe same as no o6/ectlon if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
n�_ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
� /0
Signature
%y7ot1?y P Holy
Print orType'Name '
CMR y20 B 0 X 177f
Mailing Address
AF6 AE C712LE?
Citylstatelzip
Telephone Number / Email Address
02/07/2021
Dare
(Riparian Prop�rty Owner Information)
Signature
/4ie6,iel A t3<ff„?n-nc,?
Print or Type Name
126 51ectric Ave
Mailing Address
Lew,Sf-cw,q, PA 17C9q
City/state/Zip
Telephone Number/Email Address
d�Id�a
Date
(Revised Aug. 2014)

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