71106A_Linda Old_20180823

11 CAMA / ❑ DREDGE & FILL No 71106
B C D
GENERAL PERMIT Previous permit#
KNewModification ❑Complete Reissue El 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 i 11uv
XRules attached.
Applicant Name L; n aG O I Project Location: County C, , ,, r , A y L k
Address al3 } btvmsty Rom►
City Mo uc r Statell,,� ZIP
Phone # (25,,,-) ;to',�- 3435 E-Mail
Authorized Agent
Affected ❑ CW )(EW ❑ PTA ❑ ES ❑ PTS
ElOEA ❑ HHF ElIH ElUBA ❑ N/A
AEC(s):
❑ PWS:
ORW: yes / 6 PNA yes /61P
Street Address/ State Road/ Lot #(s) �L 3 -4 R f s_jr vl ss y 1? J
Subdivision ---
City c k ZIP a -4c, 4
Phone # ( ) River Basin 9.S!5„ .,
Adj. Wtr. Body������K��n��nat /man /unkn)K��n��nat/man /unkn)
Closest Maj. Wtr. Body���r��k�����
g Platform(s)
■■PE
nt plicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) %2' !J %W -4'4 Check #
Permit s rimed Nam
e
$Jd�3)�o►� 1J•'��holg
Issuing Date Expiration Date

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: D i cl
Date:
Permit #: -- I 1 '-� V A
Describe belo'V the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
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)
D (�' �,,.,
Dredge ❑ Fill ❑ Both ❑ Others
a U
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.n_et revised: 02/03/10

V
ADJACENT RfFiAtTiAN FROPER T Y Oti WER STATEVEE
° S
I hereby certify that I own property adjacent to 4 �H c�i.55bAC
t prone rtq Ownerl
G
property located at J C s P
(Address, Lot BI ck, Road, et .)
�"I
C lri I- ��c)c �(� 1 p lrin` in O , . NC
(Waterbody) ( ity/Town anci/or County)
The ai�pljcant has described to me, as shown below. the development proposed at the above
location.:
+/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing deve)opmem-051 iiri i�•� des�sip tr✓.�. tye{ ac " attar-h. a site drawing
rrt
WAIVER SECTION
I understand that a pier. dock. mooring pilings. boat ramp, breakwater, boathouse, lift, or groin
k50 bP set .ha a minimum distance of 15' from my area of riparian .access unless waived by
m . (if you w to waive the setback. you must initial the appropriate blank beiow.)
�A 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner fnformafion f A�jar^�rrt Prop` r.ty f wnpj Jnfp�mation)
- Y • �I a�YNL� �'r'" "
:5r��ttuttn'
Print or Type Name Print or Type Name
a3? VUVV► el
Mailing Address Mailing Addre s
Cit/Sta
Cittoip 2
Z
Telephone Number / email address Telephone Number / email address
Owe
(Revised Aug. 2014)
'Valid for one calendar year after signature`

It
ADJACENT R(FARiAM PROPERTY 00AVER $TA TEA.11ENT
I hereby certify that I own property adjacent to s1 ),
pat Prager Ownerl
property located at 6 21 la V V1-7>
(Address,
LA rf , \S a't Vld in
(Waterbody)
Block, Road, etc.)
I mi 0,1-V
own and/or County)
NC
Thp a�iglj.cant has described to me, as shown below. the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attACb. a site drawing)
U.OI Z
WAIVER SECTION
I understand that a pier, dock. mooring pilings. boat ramp. breakwater.. boathonse. lift, or groin
must be setback a minimum distance of 15' from my area of riparian :access unless waived by
me. (If you wish to waive the setback. you must initial the appropriate blank below.)
L/<do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro erty Owner fnformaiion f (Ad* ae t Prey owner Jnfhrmation)
1, •'` ►i
51 J citurc Q
�l i4 I � lc_Jl.S�
Pr �t or T pe Name
PrnttorType Name
fling Addre s `'1' -
i Addres I l.(,C� 0
City/ to ip City/State/Zip
Telephone Number:/email address
Telephone Number/email address
l Jnlc' Date �
'Valid for one calendar year after signature"
(Revised Aug. 2014)

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