71591_Martin Sprysenski_20180801

CAMA /,DREDGE & FILL No 71591 B C D
GENERAL PERMIT Previous permit#
XNew . _Modification ❑Complete Reissue ❑Partial Reissue 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 C�//.
L�l Rules attached.
Applicant Name /jdi /N SIiK�SE /US Project Location: County �;;7l/
Address A
City C'N al>6t! Stated ZIP Z71 Z l
Phone # (152) ?a-24M E-Mail
Authorized Agent
Affected ❑ CW Ak )<PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
;kts C PTS
❑ UBA ❑ N/A
Street Address/ State Road/ Lot #(s) 1 ► 4
I I-i n .51 Izc �
Subdivision / i(L 1•)Su
-�+t-/iLli)�n► u,�,� ZIP ZZ/
Phone # [phone]' 4y River Basin P'1S42u'%NNe
Adj. Wtr. Body F//SCRIG/_WV- d :) man /unkn)

INC Division of Coastal Mgt. Habitat impact Computer &Meet
Applicant: 44*1T t ti S pfZ tAA [< I Permit M
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
;Habitat Nar�ae
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
S�v444&)e
Dredge ❑ Fill ❑ Both ❑ Other
SVN
Aavw
Dredge ❑ Fill Both El Other Other ❑
-2
-2C)
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
t
Dredge ❑ Fill ❑ Both ❑ Other ❑
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to 11A J r^' S Y I
(Name of ProPerrty9 O over)
property located at (� A ST CcYvSe'J '
(Project Site: Address, Lot, Block, Road, etc.)
on � c,,. s al L&,(tG.w C. ��� e,�r , in C G.,.ti, J�e,r., ,
N.C.
(Waterbody) (City/Town and/or County)
Agent's Name*
Agent's phone #:
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal. ,
.-----------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing develop m of must fill in description below or attach a site drawing)
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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901 No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
Signature
Print or Type Name
io A si
Mailing Address I
City/State/Zip j
)- S., r/y Z �, 0 � cl
(Adjacent P ope Ow, eq r Information)
Signature*
Print or Type Name
/
I b (v %-Z
r
\�
Mailing Address
t
City/State/Zip
r-
1
Telephone Number/Email Address
Telephone Number/Ema#-Address

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