62243_Uncovered Slip_20171013

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NERA L, PERMIT,,-,,Pirev''ious, permit# ,
(New OMo ific tion 'nCcmpleteReissue EPartial- Reissue, Date"previous permit issued
As authorized by the State'of North Carolina; -Department of Environment and Natural,'Resources
u'r omm'ission in an area o environmental,
and the Coastal'Reso Resources C f concern pursuant to 15A NCAC 0
'T7Rules -attached.,
Applicant, Name _C � A, 0 q Project, Location: Count�
Address 14 b\0 Street Ada,ress/'State'116ad/ Lot #(s), -w6):
City. 2t, Sfi State M zip �7467
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Authlorized,Agent City C 0 L U M P, I I zip ;??725-
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Applicant:C 1.1ARLIjzr�d-SALLY GADS
Date: ) 3 ocr 20 f'}
-General Permit#: C O 140 -9
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/ortemp
act amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tempimpacts)
FINAL Feet
(Anticipated final
disturbance. -
Excludes any
restoration and/or
temp impact
amount)
(j ��
Dredge ❑ Fill [I Both ❑ Other K
�� F
lim
1 G FT
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 ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 04A(W i_LV C-A i717 s
(Name bf Prope Owner)
property located at 1 35 17AV,6N- Z — �6Y-
(Addr, ess, Lot, Block, Road, etc.)
on Cu-D0OQ&(apf & at&q- , in _aluav o.q aiaw'ru- t-rv..
(Waterbody) (Ci y/ own and/or unty)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
tA­\�In . I have no objection to this -proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
°(Individua/;proposing-�developinent;must Hil in description•below or at#ach a.site drawing)
A o cµCL� SC ERSJDa� ,2 NFv�I
C aAL_
gas Jr
Cau. h,8 A� n0c z7RzS
CPW ijL_ ..---
DA,/WNP ©tze L__J P9JPKg--rY
WAIVER SECTION
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.)
". ir\ 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)
&a4-& &vwo
Signature Sig tune * , -rin f
6fgARLiE (�'AJ� e,--1
Print or Type Name Print oxYype Name
9109 144u)KS99AT) _1z4( 7_1a-✓1--- '9rz-7- 6�z7
Mailing Address ling Address
W� Fag-.5� n6 2758� 1�.t1,r�-`a . 6fC- 2_79z�
City/State/Zi City/State/Zip
1 R- 5S6-�F � �C i 9/-3��-7cPso zsz - 7 9 to - 6 C5 � 7
Telephone Number/ email address Telephone Number/ email address
9,/— zo/-/ C9
Date Date
Bo:4-r
,R;1.N65
(Revised Aug. 2094)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
(—:�Nt 0 01= DA VE,
2L E d .9011v g-A 1
(Name of Propp ty Owner)
.T ' C 113 -1
I
(Address, Lot, Block, Road, etc.)
on-RiVEPL , in COLW-Y\0iA ('-r-,igRELL. C N —10 N.C.
(Waterbody) (City/Town a d/or County) V ���,�.,�
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 dete'lopment must.fill in description belovir,or attach a site;.drawin�r) /� t+i�
c�
a
CANA 1_ ' ..
� r
0 .0
,2 �KiSTitJ(s
r TiE Ut
pft-;rjcS
WAIVER SECTION �H�c9R i =C%/or
��understand that a pier, dock, mooring pilings, boat ramp, breakwater, boagroin
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.)
035 Doves-Paar RD
X7 CJ Z'S
CAd4 L'
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop rty Owner Information) (Adjacent PTpertyOwner In ormation
Signature - Signature
CMW e-,G 1711 AFL 1-1JTIfE'R )tr
Print or Type Name Print or Type Name
A109 3W WFsi CgleKA5�W RoRP1
Mailing Address _ Mailing Address
WAKE- Fd 6 aA N C— 2 75 -87 VIKCIAA4r 164/f4. 114 2 3 #&Z
City/State/Zip City/State/Zip
i6 `T-.I 99- 0923
Telephone Number/ email address Telephone Number/ email address
9—/— z®/ °7 9— 7-.). 0 l °i
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*