68367_150' Bulkhead_20171012

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GENERAL
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i e i '0 us 0eernit. # hAs
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-aut orized-bythe Stafe,of'WrtHCarolina,560qmen i6UErvir6rmeni and Nat'uralResources
116so' --11'6f envi enta concern pu u
.1 1 .11 1 1 1 aftal ronm 9nd,be C6 ure6§� ornmissiomiWan Area rs !ant to NCAC
%N ules attached.
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Project'Liotation: ounty A L
Apolicint "t A'V fil C,
Address- Fr /i Sti et'Acdre's§%'s' e"
-Ro'a' Lot #(s)
—5
-ZlP,''2J
State City, 0 I
E ail
fi 0 6 # Ll --M Subdivision IIAV
A L fth6hid Agent�%'�-.� ZIP q `2— J` Fcity C�n LW A VA
Affected
PTS Phone # q;rj) q pj 837- River Basin PA. JA 07-/-1 AIX
—N (VI El i:w, • J , EW PTA
-171 OEA' El HHiF El 1H El UIBA 0 N/A
AEC(s):'- , , ! ,- - - ( - Adj. Wtr. BodyAK-MARLE --SQU,-Jb (nat /man' /unkn)
EI Pws:'
Closest Maj. Wtr. BoclyALEEMAIZLI; sood'D
011i yes PNA yes/
I Type
pe o I f Pro I ect/ "Aw7mi 1501 eworm-
ACtiVit-f
(Scale:/
Her �ddck) ngt I , le h
Fize
Floa
Groi
01L
Bash
Boat
Boat
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Otho
Shoff'
SAV:
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Phot
,"Wahi,
Pladpirm(s)
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inIg-Platforni(s)
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number,(".
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ead/'Ri-prap length lco
a�g dis ' tance offshore
MIMEM
NONE
m ax distnce'rfish
channel
MEN
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NEW
r.Attached:, 'Yes AM,
A building permit may be required by: T)"J� R rLI, C 0 U; A] -)'Y El See note on back regarding River Basin rules.
:.(NqtOLI-o ' cal Planning Jurisdiction)
Notes/ � 'S 6 6c i a1 Conditions" 't3yUjob, rnmpl 17oAL5. W(Al-L VinAl- IJALI:-
Agein'vor, ApplicaTt Printed ,N
lica , t id n Fee(s)�',-
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me 1
Perr
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b6�cesiat'drn""" k' -
rmit
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it Officer's PHnted Narr
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Applicant: � DN�1 f'L c l Avc, a Lr %
Date: l 7 p c j 201?
-General Permit #: 0
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 blame
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)
}�pR�U iZ
Dredge ❑ FilkL Both ❑ Other ❑
F 1
1S4 FT
SHALLOW
r)j'fpjll�
Dredge ❑ FilIBoth ❑ Other ❑
306F
3 00P Z
G
Dredge ❑ Fill ❑ Both ❑ Other ❑
5 O T 2
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 ❑

MA i'J
fJ ilAM'A / REDGE &• FILL
EN'ERAL PERMIT ~Previous "permit#
❑Modification- ❑Complete Reissue ❑Partial Reissue Date previous permit issued `
As authorized by the State of North Carolina, Department of Environment and Naturid'Pesources
and the Coastal Resources Commission in an area of environmental concern IiANCAC pursuant to +j1 ;
JPMules attached.
4
Applicant Namet � N t % tfLf W Project Location: County '1? j7�'7i U-
Ad.
diess- , Street Address/ State Road/ Lot #(s) C?
{,L. State j, ZIP �3' f/j111�� pt 3)�/�7Z
City ^�
Phone # ( �! t j� _Mail
Authorized Agent fir-
ElCW PTA C&S PTS
AEC(s)':
Affected ❑ OEA ❑ HkF ❑ 11-I ❑ UBA ❑ N/A
- ❑ PWS:
®RW: yes / no PNA yes On
Subdivision 9 �10 j) 57�, N A Vr
City if 0 t l+tq.6 iA
ZIP � -• `i2
Phone # ( ) River Basin
Adj. Wtr. Body /F Z )31~, IAfZit � 0 w��• �;t)/man unkn
Closest Maj. Win Body A Z _R)�HA r
• 4.r .1?
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•■lJl■■■(■■■�■■Hf■!!■i■■iiiiri��l-iiM®■■■■
- MEMMOM!!iEM■HM�EMNON,
_ •
MUMMEMMOOMMENiffid
s
AgentorApplicant Printed Name
41
Signature P-(ease read'compliance statement on back of permit"
i
-•. • Application Fee(s)' Check #
Pe rmi ffic is Printed Name
Signature �•
201
Issuing Date Expiration Date -

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to M J? Al d�'�I �,( �GI-J,CJA,1 's
(Name of Property Owner)
property located at a` . R,—) /f-O DI'S 14AV -A) f)R 44;0 L-OT
(Address, Lot, Block, Road, etc.)
on !c k Scw 5L; , in r,1,4 uoiBI.4, IVC (/sei29.t,,t -elpe, N.C.
(Waterbody) (City own 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 DEVELOPMENT
e;�:,; "" y^r""a. ':::s.: . "S.p�z.• _'i;-N=s.� sca... ,:»-,«.sue a �„k ">.-w z=....+„r';: .,,.;, ;',`.::x„"yam:
rdaaatrlaptienj� stitz at�to;iei�vac%:i drarrt
12,eCa,vsTi2ve T' Ruz/.e/ !_z; D 03�kUAl��, i;�
o Lx1Y-5, 4 ID i =��t'_ xA PleOx, J �$'o Gu/�T�'�2J-/'G�
/lJeLc1 _�,r /;X1ST�n>�jr i�KH+3
Rk-1kiJ
�ce 1n/L,C.
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 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property wner Infor atio )
_�G
Signature l
Print or Type Name
Mailing Address
City/state/zip
I"elephone Number/email address
//`-.I I' -/G,
Date
(Adjacent Property Owner Information)
Signature*
Print or Type Name
Mailing Address p ?-3 Ll�- L
City/State/Zip
Telephone Number/email address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own properly adjacent to s
(Name of Property Owner)
property located at �Q140 DIES 1.44M.,V 6R 4,v© AL27ACAIr6 L-07-
(Address, Lot, Block, Road, etc.)
on %�L Qi_�'W'4 ��� s�� 6� / , in ugj rVC 7 tf12Z9-U e-O., N.C.
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
X_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(trtditriaii?ialpro�osi Y afea��eCoptne��csi�fl�,,,t�.r`�descrapiron�be�'ovu�ot�a�fach�a,�sfe�a"�iiin"g�
1'2-PCoAvS Ti2Ue T" %;V e
k>sTi'v� 4m,1'tr9 ,3V1-.X1f 5,4 ID
A,4et r )
Rkjj -r,
12vck'
/;XtsTinr� 13Khtt�
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 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property caner Infor atio )
G
�, Signature
Print or Type Name
(; 7/3 >f>TF_ woo/3 ST
Mailing Address
C't /State/Zip
'Telephone Number/email address
Date
(Adjacent Pr,4perty Owner In"ation)
Print or Type Name
Mailing Address
city/Sta /Zi
Nlep o umber/email a-rTrlrpss cony
Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature*