71181A_Rhonda Forbes_20180926

ItCAMA / 41 DREDGE & FILL
GENERAL PERMIT
[ 1New ❑Modification ❑Complete Reissue El Partial Reissue
N271181 ® B C D
Previous permit #
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
Rules attached.
Applicant Name Project Location: County C,, r r - V ✓c / C
Address 54q f? nee» A ✓,ru k' d
City \)IW ,,,,G , 4N State\IA.ZIPa3�1
Phone # ( ) E-Mail
Authorized Agent Kt I 1 , 1
Street Address/ State Road/ Lot #(s) _) 1 b b 5,1 . L, 2 cf
Subdivision C r ova 'aAdr < k
City Cu r . 1\4 ZIP
Affected ❑Cw [)(Ew XPTA I)dES ❑PTS Phone# ( ) Uc i River Basin e. c 1�
s ❑ OEA ElHHF ElIH ElUBA [I N/A
AEC: '. ElAdj Wtr. Bod PWS: Y C ,r®t til le r,, } } S, lJw, S r (nat / /unkn)
r1--4. Mei Wtr Qnriv V✓ L'C 5'_ , J
-k � 1) I�_rlq 4 sG�
(Agent orlApp)(cant Printed Name
Signature a' Please read compliance stArihent on back of permit
Application Fee(s) Check #
Permit Off ' P'n'nt N
Sign' ure
ql a%O-;tolof
IssuinD to Expiration Date

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date:
Permit #: _� 11 �5 I A -
Describe belo'�r 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)
S DI
Dredge Fill ❑ Both El ❑
-� 3 00
3.600
�j
Dredge ❑ Fill ❑ Both ❑ Other ❑
5cej!�
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 ❑
0(-) x X 1 Z
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net
3110

NCR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date ( - / a `
Name of Property Owner Applying for Permit:
honc,n. 1�oy 6t5
Mailing Address:
5 �f" 4 -Pr "')(ASS 4nt3e--Rk
U u— pao-kat"k V-A a- 3 L-SI
I certify that I have authorized (agent C� lJl o 64 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) C reC� Qom, CQ Y14
at (my property located at) U dJ rn ► A -AC
This certification is valid thru (date)
F,
Property Owner Signature
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagementnet
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled � 90% Post Consumer Paper

■ Complpte ifems"P,.2,,and S. A.
■ Print your name and address on the reverse X
so that we can rrfitrn the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
i1. rticle Addressed to:
YACSL
A
VA
❑ Agent
❑ Addre
D. Is delivery address different from Tm 11 ❑ Yes
If YES, enter delivery address below: ❑ No
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(II'lll
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Priority
❑ Adult Signature
❑ RegisteredMalTTm
9590 9402 3813 8032 3095 54
❑ Adult Slgneiure Restricted Delivery
❑ Certified Mau®
❑ Registered Mail Restricted
Delivery
❑ Certified MaH Restrcted Delivery
❑ Return Receipt for
❑ Collect on Defivery
Merchandise
2. Article Number (Transfer from servira faha0
❑ Collect on Delivery Restricted Delivery
7 Insured Mail
❑ Signature ConflnnationTM
❑ Signature Confirmation
015 1730 0001 6197 9322
:Insured Mail Restricted DSINrery
Restricted Delivery
, lover $ )
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt

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.VI ip BEACH VA 23451
OASTAL MANAGEMENT
ertified Mail Fee
$3.45
Y
�'
IERTY OWNER NOTiFICATiON FORM
box, add tee ate)
��'
TURN RECEIPT REQUESi'Et3
jdra Services & Fees (check ! f�
Return Receipt (hardcopY)
0Return Receipt (electronic) $
Certified Mail Restricted Delivery �
—7'
Postmark
Here$ I00
1 _
/r]'lCJ
ko
O Adult Signature Required $
Restricted Delivery $
idjacent to 1 6� le S� 1� mc(a
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S 's
Adult Signature
Postage sn � 50
U
06/13/2418
([dame of Property Owner)
^^--��
$ ,
Total Postage and Fees
$6.70
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Block, Road, efic.�
o (, -A
N.C.
-- . - -
-,-I u_
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k
(Cityrrown and/or County)
r , ,rr •r.
Agent's Name �� �[IA a Sd 0 Mailing Address:-P 0 6 G X
Agents phone # a5Q -'-51- S oq-(p U Y-°
He/She has described to me as shown below the development he/she is proposing atthat location,
and I have no objections to the proposal.
^ -- - DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT
(individual proposing development must flit in description below or attach a site drawing)
d.re C .e, ca-n j +Z) a ! 16 w tDO04 Q. ACC -SS
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCIN) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 1357 US
77 South, Elizabeth City, NC, 2790.9. DCM representatives can also be contacted at [phone]. No
response is considered the same as no objection if you have been notified Yy Certified Mail.
(Property owner Information)
Signature
Print or Type Name
Mailinq Address
CitylSfate)Ep
Telephone Number
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address
CitylStatemp
Telephone 14umber
Date
Date

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Agent's Name
Agents phone *
ASTAL MANAGEMENT
:RIY OWNER NO
URCATION FORMI
'URN RECEIPT REQUESTED
adjacent toe kay k s 4�:R k 0 JN40. dibcs-s
(Name of Property Owner)
N.C.
(CityiTown and/or County)
Mailing Address:--�6 G8Y
CZ7-f�l N�
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
--------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
40 a 1) 6 w --tco r e as �ooc a cue ss
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mayed to 1367 US
17 South,
Elizabeth City, NC, 27W9. DCM considered he same as no ob r fonlif tives can ou have 6 on no 'fled i y Ce cordacted at� l�9. No
response
(Property Owner Information)
kSignafu
Prinf or Type Name
Mailing Address
Crty/Sfate/Zip
, ",'n\
Telephone Number
(Riparian Property Owner information)
Signature
Print or Type Name
Mailing Address
City/Sfate2ip
Telephone Number
Date
Date

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