40708_BARNES, MIL_20041216 (2)

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AMA / ❑ DREDGE & FILL1� Y 40 A 0O
ENERAL PERMIT Previous permit #
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7%' l2'G
,�� ❑ Rule attached.
Applicant Name 'Ytt L AProject Location: County
Address ot- 5'Vr Y-1; Street Address/ State Road/ Lot #(sue) ,
City_: Y h Ginnr. tate A;C ZIP �} L f� - r' i
Phone # (`' /) )16Y -X6 Fax # (
Authorized Agent
Affected ❑ CW CatW i-r to ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
Subdivision
City _��lf ��' ZIP
Phone # River Basin
El PWS: ❑FC: Adj. Wtr. Body*fC,r; Cyee- L nat Loran /unkn)
-1-1 Closest Maj. Wtr. Body 3c i,e- S6t'4;
©RW:. yes /�io� PNA yes / o Crit. Hab. yes / no
Type of Project/ Activity yP 1 y X
(Scale: .0 7S
Pier (dock) length 5 ' X
Platforms)
Finger pier(s) 1 l t. r� C(-&e 1L
Groin length Iyfii
number
Bulkhead/ Riprap length��
avg distance offshore
max distance offshore
Basin, channel - - - - ---- - - ----- -- - - - --
I
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
f 60
Shoreline Length
SAM not sure
yes
Sandbags: not sure
yes
iq
Moratorium: n/a
yes
Photos:
yes
no
Waiver Attached:
C--�
no
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions Alo
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
o `5
Application Fee(s) Check #
A.k
117--1il?-()4 3-A, _
Issuing Date Expiration Date
Local Planningjurisdiction Rover File Name

CYNTHIA F. BARNES 4-f)C 1f0%Ci--CAP 2885
NCDL 1747022 Ph 919-489-8969 Asset Management Account
2700 Surrey Green Lane 66-21/530
Durham, NC 27707 % �es — G� BRANCH aasoa
Date
Qo
G der of
V lVt-li' JN�(i1 aito� �C � ollazs
WACHOVIA SECURITIES CODE=
Wachovia Bank, N.A.
For U ��
+:0 S 3000 2 19l: 400 �0638
1ii0 288 S

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to I 's
(Name of Property Owner)
property located at 13 CA �— Yr/ Yl S A '
(Lot, Block, Road, etc.)
on 1 5
in , N.C.
( aterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback. requirement.
I is Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--- -------------� -------------------------
----------------------------------------------------------------- C
Sig tore
Print or Type Name
?7 7/
Telephone Number
Date: /'z f y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to �' l L/��J�V e- 6 s
((Name of Property Owner)
property located at
(Lot, Block, Road, etc.) '
on in «� rc� 2� , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I l& wish to waive that setback requirement.
---
--------------------------------------------- - - --
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP`NIENT:
(To be filled in by individual proposing development)
----------------------------
Signature
�2C//c:�7 661-
Print or Type Name
Telephone Number
Date: / 3

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