62675_Install 13 x 13 uncovered Boatlift_20180505

:. [�CAMA / ❑ DREDGE &FILL y�Ua�'15 N2 12153 A C D'
GENERAL PERMIT Previous permit # N
pNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued N 1 A',
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 U 7 Z- �U
[Rules attached.
~— Applicant Name WAt-TE — G�-SP
. ,..-_Address O Z; DX I 1 j
-CityState 1J C. ZIP '7---7'32q
-Phone # E-Mail
-Authorized Agent
ElCW. �EW 'g'PTA ` „❑ ES ElPTS
Affected
AEC(s): 0 OEA ❑ HHF ❑ IH El UBA El N/A
❑ PWS:
ORWi- --yes /cry PNA" yes / no
Project Location: Countyt=Q"u r n�-� ��•:
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River BasinTA---- QAMLI t v
Adj. Wtr. Body J^ r 1 • / ^ lY. ,.- �A-1_ (nat�/m�a►r/unkn)
Closest Maj. Wtr. Body—
M.
Agent or Applicant Printed Name
Signature ' Please re dad„comip ian ( cstateue tjeennt on back of permit**
Application Fee(s) Check #
'7
("",permitOffcer's Printed Name `
S� ature
5-MFI^7 -Z615CNY,1)t: -L&
Issuing Date Expiration Date

I hereby certify that I own property adjacent toy I/rl;L
properMocated atcaW
(Address, Lot, B
onZ, in
(Waterbody)
/L/ o,AMW ?10--
rWM" 7611
J",-
AN,
row/11Yand/or Co�t_y)
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
- =" ;:;ram ^^'��''�-;.ay'=�'°y_-� :.'�"-,-���r �.-^�--.�=� >; '�-,x_ � -��- 'I;T,'-•�-r.
Jerre onenst x _, =eserprelagcai:
WAIVER SECTION
1 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.. r(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 jnformation)
oA7AX
Prin e r e
N� c
AV1Ta'/s Ma liyg A dres
3ta�t� i 2 CW, 3aaa�?
�hpne umber/email address Telenhop umber/email address
�/ �� 4o
T Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*

I hereby certify that I own property adjacent to YVAU.4A 's
Nam Pr O IecJ�
property cate at
• (Address, Lot, Bloc oad, e
on , in , N.C.
aterbody) (CitylT ' n 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 _
�na►i�daa�v� o�sr�>e>�lap. �n,�i�.rrxrts���I��,a�e�cr�pfiot�bel�=ol�a���-scfi��i�%,g;
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.
do not wish to waive the 15' setback requirement.
(Property Owner
Z5Z-714e- 3 v z_<'z- 710 99; z
Teleph n Number/email address
Date .
"Valid for one calendar year after signature*
(Adjacent Prop rty caner Information)
Y�
sIQI� ture*�•
Pnnt or Type Name:
Zo 3 U D OX,,
M 'If g Address �witAi
City/
Gtate/Zip 1
o9z' a/tYtw (ICI Yi�G,v l - GDYI1
Teteoho a Numb / email address
Df* --- -
(Revised Aug. 2014)

Applicant:
Date: 6-
-General Permit M
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 Ma me
DISTURB TYPE
Choose One
TOTAL Sq. Ft
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
. FINAL S- % 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)
01�
Dredge ❑ Fill ❑ Both ❑ Other.19
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 ❑