87255A - Franklin, Justin

®� ❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
Na 87255
Previous permit
Date previous permit issued
A, B C D
New ❑ Modifiication ❑ 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
I - t :� �� '
❑ Rules attached.
❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Named
vt k:. i i v)
Authorized Agent i' + 1 I \J
Address
d`-'
Project Location (County): i t..t. C e I U c-
City State
ZIP
Street Address/State Road/Lot#(s) (
b' !'V e".
Phone # ( )
Email-.
o E1-,
Subdivision
City ZIP'
Affected ❑CW ❑EW
❑ PTA
❑ES ❑`'pTS
Adj. Wen Body :a I (. (6—
nat%an/unk)
AEC(s): ❑ OEA ❑ IHA
❑ UW
❑ SPIMA ❑ PWS
Closes[ Maj. Wtr. Body 1. c. r t �.:: i-:
l t �•'�-
ORW: Yes/no PNA: yes/no
Type of Project/ Activity
`x'i 'i - Y, e'•
-, <l _
:e•y e°}a..:•,csa"t'"
(Scale:t
Shnreline I eneth
Access Length—
Pier(dock)length,L
—
-f"-'
F
--
Fixed Platform(s)
i
'-.)r
-
-
I
—1
�'f'`
i
I
L--
II
f
Floating Platform(s)
Finger piers)
Total Platform area
Groin len gt h/q
_I_
_
12
4iC,
4
flt
i>3
k
Bulkhead/ Riprap length.
.,.
�—
I
---
I-
i—
—r
C
.i
1._-.__
_
A.
_
Avg distance offshore
Breakwater/Sill
Max distance/length
—
/-;
Basin, channel
rF-
Cubic yards
I
r
—
Boat ramp
I
~
I
I
,
I
_
L —
Boathouse/Boatlift
����.
,.�,
,yam
!
T
"!
'
�
1
I_
Beach Bulldozing_
Other
SAV observed: - yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: -yes no
'..--
A building permit/zoning permit may be required
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
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature ""Please read compliance statement on back of permit**
l.y :i3
Application Fee(s) Check q/Money Order
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1 •+S t r Year �,
Melling Address: t15 Ltclt- dr,vC
o I ot, Y- tic 2145b
Phone Number: -7S I •2-1D - 00 3�1
Email Address: 5hoclr t' Ak-AV l2_t` a ,11 rc . Lo
I certify that I have authorized __o V 4-Qll:4 P �l / alej n r� iCn S�YL'(h V V)
Agar ctor (Gc'
to act on my behalf, for the purpose of applying for and obtaining all C (AMA permits
necessary for the following proposed development: f , K 30' 7 /�
doct I-ykn5abn and [JAL Bc .uii f! tong (h nor Piv�(vp
at my property located at I d s" (=C D C. f !' cc lr-- , A)( 215 SI ,
in <�rr,fuctc County
I 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
an the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Title
11 Ili 13
Date
This certification is valid through _I I
ffq 1 5 r•e S

■ Complete hems 1, 2, and 3.
"""'" �, n
`
13 Agent
■ Print your name and address on the reverse
X �y f
Atltlreseee
so that we can return the card to you.
■ Attach this card to the back of the mallplece,
B. Received ubvLvy(Printed,/��a'm_ e,)
. Date of Delivery,
- t-%3
or on the front 0 space permits.
L'rrJ`� id"av h'
Q 2
1. Article Addrmod to:
D. a delivery address different from item 1? ❑ Yes
I f YES, enter delivery address
belw.. ❑ No
I'30't W
IIII�i
3. Semloe Type
Cl Priority Mall
'pre
III'III'I IIII IIIIIIIIIII IIII�IIIIIIIIIII III
AdWft
gyn
Xasbanlod-
III
aeectW DeH
❑tMx
9590 9402 3871 8060 851319
s c.mned Male
❑ Grafted Mall Restdcla calvary
Dlt Receipt for
coilecton Wivay
❑ Cdkct an Delivery Reatdola Delivery
0 Moaned Mai
D signature WrnlnneflonTM
❑ Si~ Con6rmalion
2. Alikle Number (pienalerlrom 6ervlce IeheU
7020 2450 0000 6216 2072
110111 ResMola Wbw
Iloalda Davary
Dornestio Return Receipt
PS Form 3811, July 2015 PSN 7630-02-000-9063
■ Complete items 1, 2, and S. '•'
a Signature
- O Agent
■ Print our name and address on the reverse
xl �/�-�' �
O Addreaaa
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
a. egved by lPNe rintedme)
0, Den of every
le, 14,% 11 %
12JI2
or on the front if space Permits.
r"7
1, Ankle Addressed to:
. la delvery address tli0went from flem l? ❑ Yes
/ -
If YES, enter delWery address
babw: ❑ No
KI e`� A
pp
V�—
.3. Service
R1c�taw�ooh a�'cYlhe+t ¢. Cczrolcfh
123 Creek 3?r• J

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