87256A - Leach, William

tA Occur" ❑CAMA ❑ DREDGE & FILL Nn 87256 A-. B C D
GENERAL PERMIT Previous permit
i 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc goy/CAMArules
Applicant Name
Authorized Agent
Address
Project Location (County):
City
State
ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email
Subdivision
City ZIP
.Affected ❑CW
DEW ❑PTA
DES ❑PTS Adj. Wtr. Body (nat/manjunk)
AEC(s): ❑OEA
❑IHA ❑UW
❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no
PNA.'yes/no
Type of Project/ Activity
(Scale:i )
Access Length
'a
-
-
Pier (dock) length
h J
1
r�
,,
T
L
,,y.-..
1
Fixed Platform(s) rz
i
�._,6
At
-
FloatingPlatforms
Finger pier(s)
I
i
44
r'
W'
s
i
Total Platform area : r- L
1
I
I
I
I
I
Groin length/fl-
_
Bulkhead/Rlprap length
�
{�\
�i-
Avg distance offshore
Breakwater/Sill
"(
Max distance/length
I
Basin, channel1-2
Al
Cubic yards
Boat ramp
I
I
Boathouse/ Boatlift
f
l
1
r
Beach Bulldozing
Other.
I�
- —
-L
SAV observed: yes no
Moratorium: n/a yes no
—
�I
Site Photos: yes no
f--r
--
?
-
-----
-
-
T
Riparian Waiver Attached: yes no
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1
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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
(Please Initial)
Signature **Please read compliance statement on back of permit`*
Signature
Fee(s) Check N/Money Order Issuing Date Expiration Date

Name of Property Owner Requesting ermit:
P
Mailing Address:
0
Phone Number:
Email Address:
I certify that I have authorized
i
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 G � i rICJ11 LN
in w CL -- County.
l 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:
Print or Type Name
Title
l lei t
Date
This certification is valid through I 7
Revised Mar. 2016

N.C. DIVISION OF COASTAL MANAGEMENT
OWNER ;., ADJACENT RIPARIAN PRri RnlErtF(Y P REQUOES EDAorfOHANDADEELIVERR
(Top portion to be completed by owner or their agent)
of Property Owner L
littla
Rat
M of Property ier
g Address of Owner. ? ` _ / 6O
rsemail: CJ Ix 1.�MOwner'sPhone#. ��i r� (�be�o �3 L�
's Name: eAAa VII Agent Phone#
es Email: 5�jf'�1W�1 Cb��[ w % 0 . �A✓"L
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Bottom portron to be comateted by the Ad[acent Property Owner)
The individual applying for this
I hereby certify that I own property adjacent to the above referencedproperty.
development they are proposing. A
:+ h.. rincrnhnd to me. as shown on the attached drawing,

N C. piYiSiON OF COASTAL 1jiANAGEME ER FORM
ER NOTi"CAT1ONMfAIV
A PARIAH PROPERTY PTRE UESTED or NAND DELIVERY
tobe compieted by owner or their agent)
tl
_ Owne{s Phonetk �y
�— Agent Phone# vA
PROPERTY OWNER'S CERTIFICATION
RlPARIAft _ . _ .At-_e.A pmnerw owns
than own property adjacent to the above referenced property. The individual applying for this
I hereby oedify shown on the attached drawing, the development they are proposing_ A
permit has described to me,
as des �11
h dimensions must be rovided with this letter.
objectionsto this proposal• I DO have objections to this proposal
ti you have o6JeGAlons to what is being proposed, You must notify the N.C. Aivisfon of Coastal
Management (pCMj in writing within 10 days of receipt of this notice. Correspondecan nce shouldso be
thres
beth City
matt�d,to 1264-"St,
t. No restmnSte. 300, eis considered �the same as no objection ec�U n if ynwr have been
notffle0 by CetMad Mail.
wANER SECTION
I understemt that any proposed Pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 1S from my area of riparian access unless waived by me
ahia dr _q nrA aooly to bulkheads or riprap revetments). (if you wish to waive the setback. you gust sign
)mpixbt� uewm w,v...t
wish to waive someiall of the 1.9 setback G %
Signature ofAdjacent Riparian '7
erty Owner
iaharo z�#
e the 15 setback requirement (initial the blank)
:c••
MtPO\7 s Phone#:
*Waiver is valid for up to one year from ARPO's signature'
Revised July 2021

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