87015A - Tice

Or"t0 w L`7CAMA [DREDGE & FILL
i GENERAL PERMIT
Nn 87015
Previous permit
Date previous permit issued
(A) B C D
�7rvew ❑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 _U 7 (k • I 1 (-) U Rules attached. Q General Permit Rules available at following link: m derinc.go JQ6M6Cu1es
Applicant Name _� ' f �J r f. S ll" L 1 CLCS
Address �riS' i _f 1V1/a14 [XK*-V
City Mn rJ state A{ c ZIP 2:7 95`Ka
Phone # (_ )
Project Location (County): C-U•rY•t'rUr,-Ll
Street Address/State Road/Lot #(s) 1 '9 L(r Gl l ( V��"_� LO
EmailSubdivision 11
City.[ [I.: ZIP 1.'295V
Affected E]CW JEW [ PTA aE5 [�fp75 Adj. WtcBody HAs.Cit2cs J!i !c��
`_�r—nasiunk)
AEC(s): FOEA �IHA �UW []SPIMA �PWS Closest Ma). Wtr. Body_[urY t�li!``K/ �e�Ul
ORW: yes no' PNA: yesIio,7
type of Project/ Activity
Shoreline Length i s'L'?_�„, is
Access Length,
Pler tdock) length
Fixed Platform(s)
Floating Platform(s)
Finger plerfs)
Total Platform area
Groin length/B
9Tv head�)Rlprap length_____
Avg distance offshore - sa r
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift j
Beach Bulldozing
other.4
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SAV observed: yes no� '� �� ••� j rice.
Moratorium: n/a ye no ✓
Site Photos: yes nod
Riparian Waiver Attached: s :Rol I lk
A building permit/toning permit may be required by: r 1 1 -vc :. r ry s J aL-q
Permit Conditions
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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)
3gnature •'PJease read compliance statement on back of permR;
%pplication Feels) Check g/Money 0rder
Signature t
Issuing Date Expiration Date

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(jtGE
AMA [EDGE & FILL DRN9 87015 B C D
NERALPERMIT Previous permit
Date previous permit issued
ew ❑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 Q -7ik • 110 D ❑ Rules attached. V General Permit Rules available at the following link: wwwdea.nc goy/CAMArules
Applicant Name — C'< i � —G
Address 1-91 aUrAit,�—u LaKw—,
City rlld ilC. State J A{a ZIP Z795�6
Phone # (_ )
Email
Authorized Agent _La evt C r%- $U rei/l.
Project Location (County): C UIrV' G�
Street Address/State Road/Lot #(s) 1 9 ( <7-oU ff•Ke. LLI
Subdivision
City
Affected ❑ CW [?fEW ©PTA [?ES [�I`PTS Adj. Wtr. Body Vl LaVtttI r na an/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Win Body e' y rt 1'+UG t SAL) KA
ORW: yes no PNA: yeslg
Type of Project/ Activity
Shoreline Length i t •L Zj
Access Length
Pier (dock) length
Fixed Platforms)
Floating
Finger pier(s)
Total Platform area
Groin length/M
u head Riprap length
Avg distance offshore s b t
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
at It. Zdv K 1 v '
SAV observed: yes no
Moratorium: /a ye no
Site Photos: yes
Riparian Waiver Attached: s
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Tt se: R
A building permit/zoning permit may be required by: CU6f 1r° 6
Permit Conditions
I AM AWARE OF STATI
CRC RULES AND
Agent or Applicant PRINTED Name
THAT APPLY TO THIS PROJECT AND
Permit
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
COMPLIANCE STATEMENT. (Please Initial)
Signature -'Please read compliance statement on back of permit•• ✓ Signature I '
z7� 11 r-7
Application Feels) Check H/Money Order Issuing Date Expiration Date

❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
❑New []Modification ❑ Complete Reissue ❑ Partial Reissue
N98701.5 A B C D
Previous permit
Date previous permit issued
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 / ) -7 (1.. I 10 0 ❑ Rules attached. ❑"General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name F,r< C'\" )" o i.
Address ►4i1 _60 r-i'n (t 1...c2,v\.<-
r`'lOVOC-c- city state ZIP "L`7 l ''-) ,'•
Phone # ( )
Authorized Agent d. r;tN'€.°.vs E I— rYJ 'kIt'r,
Project Location (County): �. ! ! I' 4m r `'- rJ
Street Address/State Road/Lot #(s) I is I r J I :! ("i vk
Email Subdivision
City /A [. zip -2. `1 i! ,:7'd
Affected ❑CW ❑EW ❑PTA F]ES [E`PTS Adj. Wtr. Body 41 4;. {V\,:i /VIf r, ir'(nat)man/unk)
AEC s : OEA IHA M UW SPIA PWS ff
❑ ❑ ❑ ❑ ❑ Closest Maj. Wtr. Body f- !.i C r ! T c�i' fs-• '._:7 rc, U r . ;: {.
ORW: yes/no PNA: yes/fio_,)
Type of Project/ Activity
(Scale-YAJ 0A)
ihnreline I enarh
Access Length -
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Total Platform area
Groin length/#
Avg clistan e offshore
distance/ length
Basin, channel
Cubic yards
Boathouse/ Boatlift
Beach Bulldozing
Other
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A building permit/zoning permit maybe required by: Fri UK I" r}-vC 6.C" ca LJ tr\'1'
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'• Signature i
Application Feels) Check g/Money Order Issuing Date Expiration Date

a
it 2 ',1-;''t

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date �, - V - 13
Name of Property Owner Applying for Permit:
0 it /' W J2 7i c ,. <.. / Y E-'v
Mailing Address:
l 0 / Gou.,-- n-cv Za rr
I certify that I have authorized (agent)
Lauren Berry Burch
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) / d o P,,
at (my property located at)
This certification is valid thru (date) (p -- Y- Z i4
Property Owner Signature
Date

■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallplece,
_or on the front if space permits.
-"-' D. Is deliv
If YES.
ISS `Co�x� LN
UC_ S­I q 5�
III'IIIII I'II IIIIII III'IIIIII IIIIII IIII III Jill ° drt gri e 9590 9402 7485 2055 1
❑ Agent
Fame) C. D to f
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'ewnt from Item 1 Ye:
address below. ❑ No
❑ Pdodty Mall Express®
❑ Registered Mail-
Cl ReeD.ggistered Mail ResMcled
985 69 ❑ Cerufled Mall Restricted Delivery ❑ Signature Confirmatlon*e
2. Article Number D Collect on De1Nery ❑ Signature Confirmation
(TI'enstar fmm aam," fsb'r ❑ 0011. an Delivery Restricted Delivery Restricted Delivery
_ 7021 2720 '4002 4028 0838 Restdoted Delivery
FPS Form 3811, jury 2020 PSN 7530-02-000- 0053
' Domestic Return Receipt I

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