71214_Riprap Shoreline_20181025

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4CAMA / WDREDGE & FILL No 71214 /� g C D
GENERAL PERMIT Previous permit# l`�
®New ❑Modification ❑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 I SA NCAC
[Z Rules attached.
Applicant Name (1411Ll'iiy] K I(z -
Address F�)(—
CityFi t l/�rl StateZIP
Phone # (�),2L.,— E-Mail
Authorized Agent
Affected ❑ CW XEW 1IPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / i` o PNA yes
Project Location: County C1<4AA r)L ),l
Street Address/ State Road/ Lot #(s)
j 2- 4- t2trt vim=
Subdivision /H A It N %'v 1NT
City 51-i u, ti ZIP Z-79 7�
Phone # ( ) S� 44 C River Basin IPA l" 4517W 14—
Adj. Wtr. Body /SU? Lj,/)/Li?Lf_ is ,/man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of Permit'�`�
ApplicatibnF (s) Check#
Permit Officer's Printed Name
Signature _
62� - aSS 21> 16
Issuing Date Expiration Date

Received
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
DCM-EC
I hereby certify that I own property adjacent to l 's
(Name of Property Owner)
property located at
I ((Project Site: Address, Lot, Block, Road, etc.)
on �I L f'N�t_L JOW4 in S`n� N.C.
(Waterbody)
Agent's Name #:
Agent's phone #:
(City/Town and/or County)
Mailing Address:
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 rill in description below or attach a site drawing)
ce se,)
Keier ?"Pd,f
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 mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
Signature
611-41 ,
Print or T pe Name
P of ge)e Y
Mailing Address pp f`
S�i c AUC' 7:
City/State/Zip
Telephone Number/Email Address
/c' %.�) / Y
Date
(Adjac rat Prope"ner Information)
Signature`
Print or Type Name
C9 op
Mailing Address/ c
City/State/Zip
-2,D-a 0,? -WW1 6
Telephone Number / Email Address
Date*
*Valid for one calendar year after signature*
Revised Jan. 2017

Received
DIVISION OF COASTAL MANAGEMENT u I t
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED DCM-EC
I hereby certify that I own property adjacent to Z's
(Name of Property Owner
property located at
(Project Site: Address, Lot, Block, Road, etc.)
ony�zr�>v t� in ��t i �O�t , N.C.
(Waterbody)
Agent's Name #:
Agent's phone #:
(City/Town and/or County)
Mailing Address:
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 rill in description below or attach a site drawing l
L7/�.
rCOF—� �L
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 mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
1
Signature
L 1,17
Print or ype Name
c, epx b'6
Mailing Address
Sh IO . fUC- a+- 7
City/State/Zip
zs z) 33 (e- 4/36�2
Telephone Number / Email Address
ja n rope Owner Information)
Signature"
Print or Type Name
26 of e t4l r n w
Mailing Addr ss
City/State/Zip
Telep ne Number / Email Address
AMU
Date Date*
*Valid for one calendar year after signature*
Revised Jan. 2017

INC Division of Coastal Mgt, Habitat impact COMPUter Oet
Applicant: c4W4 /2t6GS Permit*
Date: ea- Z S 2-44 S
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
tem im acts)
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 ❑ Other
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Dredge ❑ Fill '�] Both ❑ Other ❑
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Dredge❑ FillJZ Both ❑ Other ❑
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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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