70620_Bulkhead_20171121

CAMA / ❑ DREDGE & FILL
G'EN,ERAL • PERMIT
❑Modification ❑ Complete Reissue, ❑Partial'Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an are of environmental concern pursuant to 15A NC
1V_ 70620, B C D
Previous permit # eo),10-
Date previous per' mieissued
AC
' - - •fiiTR5lnc �rr�rh'arl '- -
Applicant Name / Gf/ C/ ���f'JC Project Location: County �.�-
..
Address (G � /owe— Street Addss/ State Road/ Lot #(s) J
'Statefl%C ZIP i� rfJl
Phone # ( - E-Ma lI Subdivisio
Authorized Agent Dl/lG� / G City /�/ l6!GG/l 1 ZIP /
Affected ElCW ❑ EW PTA ❑ ESPTTS Phone # ( ) �— River Basin G,
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body / / nat an unkn
❑ PWS:
ORW: yes //oo PNA yes / no Closest Maj. Wtr. Body l i r
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Agent or Applicant Printed Name
Signature
PI as
± Applj ation Fee(s)
lianOratement on back of permit •
w 41- r�
Check #:

NC Division of Coastal Mgt. ^Habitat Impact Computer Sheet
Applicant:
Date: ;� 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.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
p�
Dredge ❑ Fill 0 Both ❑ Other ❑
Dredge X RUA Both X 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.nccoastaimanagement.net revised:02/03/10

I hereby certify that I own property adjacent to' Q L 2s
(Nam of Property O ) er
.property located at ��� -F&LO n2,tJ (�� X-/�, U/P W /,& ,��L/W)
(Address, Lot, .Block, Road, etc.)
on
tC�► P in Jo'f ![/)4 , N.C.
(Waterbody) (City/Town and/or C unty)
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 DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a- pier, dock, mooring pilings, 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 15'-setback requirement.-
__ __ I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Pro erty Owner Information)
' p�
f
Si atone r
Si Lure .7-0„ 4..i4,a,, -s se,4e j
Pnnt or rType Name l 2 9 : m' a C' ' VQ r\ ESse r.(L I:67- -
�° Pnnt or Type Name
��' fi-�rt �� n 13� ��ni,�
Mailing Address e ��`� Mailing Address '
Ci /State/Zi '---- � I kn `,P r-,
�� _ �(o Crty/State/Zip
i dal Cllo� (SS'?�
.Telephone Number Telephon Number
Date Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
(Name of Property
's
(Address, LA 131ock, Road, etc)
on �O Q , in , N.C.
(Waterbody) (City/Town and/or nty)
The applicant has described to me, as shown below, the development proposed at the above
location. .
1 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 attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 15'setback requirement.
I, do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Si atur-e Si tune �~
h � d. �%o r�' . �nn�n +rill
Print or Type Name Print or Type Name
M iling Address Mailing Address
City/State J.p City/Sta e/Zip
��- 96 `� '�o�SL 2�Z�
Telephone Number Telephone Nu ber
Date Date
(Revised 611812012)