63056_Authorized 6x 32 pier and 16 x 16 Platform_20180828

- /�111 DREDGE'& FILL _J .No. 7.2431.
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GENERAL "'PERMIT`C " p,�;.-
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Previous, ermit 'j
w : New []Modification❑Complete Reissue El Partial Reissue Date previous permit issued A j%A,
= As authorized by the State of North Carolina, Department of Environmental Quality H
and the Coastal Resources Commission in an'area of environmental concern pursuant to I SA NCAC
M!'� � � / - i[�,�3�ules attached. • .
Applicant Name N i '�A) L W �'j J Project Location: County ' �F_)Z }�[ C PS li �l
1 Address I j 2 c�yiPQ 1' S5 ��� Street Address/ State Road/, Lot #(s)
City Mr 1-1)Lt State A) zIP 315T7
Phone# ()_
Authoriied Agent
E-Mail
Affected El CW . JOEW - YPTA ❑ ES ❑ PTS
AEC(s): o OEA ❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS:
ORW: - yes / no PNA yes
Subdivision _61AC K MV-DI,
City ' O E MY 1) )1 L zIP- 793 :7
Phone # (119-) River Basin
Adj. Wtr. Body C [//1L. A/J 1 Vtfi-- at an /unkn)
Closest Mai. Wtr. Body6 1101 A 011,EA
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MMEMENEEMENE
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1151
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-Sign t6re Please
Application Fee(s) _
Z�11� _ E_y I Al V AK �
lame c PermitOfficer's Printed Name
compliancestatement on back of permit Signature
a o AVID 2oiq 2Y DF'c eU) 9
Check# Issuing Date Expiration Date

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
k
Name of Property Owner: r\ '�(\ G CY J
Address of Property: i CUB t �5 P�- rn 6,r
Agent's Name #:
Agent's phone #:
(Lot oif$treet #, Street or Road, City &
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions. must{ be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
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. Contact information for DCM offices is
available at http://www.nccoastaimani gement.netlweb/cm/staff-listing orby calling 1-8884RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER -SECTION_
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 Owner Information)
JbU P
Signature
5 L4e- AL4 cv c, lz.
Print or Type Nam
11 l b Lov.alec� W
Mailing Address
City/State/Zip 1 6 1, e
Telephone Number/Email Address
P J LAl i� a 8
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number/Email Address
Date
(Revised Aug. 2014)

on
Z heg,c that I own property adjacent to
roperty Owner)
(W aterbody)
's property located at
y
(Lot, Block, Road, etc.)
in , N.C.
Town and/or County
The applicant has described to me, as shown below, the development proposed at the above
location. I understand that any construction, excluding bulkheads, must be set back a minimum
distance of fifteen feet (19) from my area of riparian access unless waived by me.
no objectioryfo the project as proposed but
I object to
ion to the project
jest as proposed.
not wish to waive the (151 setback
and do -+rush to waive tbe1IV) setback
nESCRTPTION AND/0RDRAWING OF PROPOSED DEVELOPhv ZT:
(To be filled in by individ p posing development)
j=T
J 9�,'P-7-
T
EV A
Print or Type Name
-�'C')
Telephone Number
. - 0 - C;
D ate

Applicant f 4 A jZ f7 '� G A) L kfN I
Date:28 Auc ZorT,
General Permit
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/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
J%A
Dredge ❑ Fill [IBoth ❑ Other (�
L//g or f 2
y $ OFT�`'
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other [I -
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 ❑