72117_Replace Pier_20180612

JCAMA /,❑DREDGE &FILL
N®' 721.17 D
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GENERAL 'W0 "
Previous permit#. � �-
.PERMIT
IyNew ❑Modification El 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�/
1
�G /<
ules attached:- "-
Applicant Name Z/S:ro 1 i Project Location:
County `/! G--
Address �i� O3 I Aepe_' P4 �h ,Orlye Street Address/ Road/ Lot #(s)
/State
City 6r� IIG�' State
s
Phone # ( - /V )E-Mail Subdivision • ' �,/Ol
Authorized Agent - LDA,/ ��16_ isi�/1 City i ZIP
Affected ❑ CW ,KEW )PTA ❑ ES ❑ PTS Phone # ( )
River Basin
❑ OEA ❑ HHF ❑ IH '❑ USA ❑ N/A
AEC(s): Adj. Wtr. Body
;n �/l0 nat, man unkn
❑ PWS:
ORW: yes /� PNA yes./ Closest Maj. Wtr.
Body .�G,i�i!_rOUiT
Type of Project/ Activity J 4
-:, •-'(Scale: / =° jp '` ) .
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger piers) �--
Groin length
number -
Bulkhead/ IZprap length
avg distance offshore ®'—
max distance offshore
Basin, channel .
cubic yards
Boat ramp
Boathouse/ Boatlift
�T
Beach Bulldozing
Other �r
Shoreline Length - U� /
SAV: not sure yes no
Moratorium: n/a yes q�
Photos: Yes In.
Waiver Attached_
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
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A building permit may be required by: See note on back.regarding River Basin rules.
( Note Local Planning Jurisdiction) //
Notes/ Special Conditions 1-1AL k," !
Agent or Applicant Printed N
Si nature **Pleas • 'a compli n statement on back of permit"
CC// i
App ication Feels) _ -Check#
PermitOffier'Vyintecl 2ir1'e
Signature
v
Issuing Date - _ Expiration Date

I hereby certify that I own property adjacent tor �f`" 's
(Name of Property Owner)
property located at 7- 7 `7
(Address, Lot, Block, R ad, etc.)
ono�.r�N�� S��e�o% , in C?craCle , N.C.
(VUaterbody) (City/Town and/or County)
The applicant 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 DEVE�UMM i
lnd vfdual proposing development must fill in descripfion below or :aliach a site drawing;
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse; lift, or groin
must be set back 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.)
I do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(P o arty owner Information)
Si e re
Pr! tor Typ Name
- - r" i4l&
Mai�{{ ng Address
City/State/Zip!
`
eleph npNir�g r/emai►address
l
Date
nl
Mailing At�(lL'1 V v V a s 3 0 7
CitylstaattVL1 9 x5- (� 7
Telephone Numb r/emajL�aeldr8�s'':/V Iq
PIiz�lg
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

NC. Division of Coastal �i to Habitat impact Computer Sheet
�ff�� � <
Applicant: ��7,��ro� C%j� 1
Date: , J U/2L 9,V%P
General Permit #:
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 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)
Dredge ❑ Fill ❑ Both ❑ OtherA
ZA—
DredgeE] 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 ❑
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