63154_Propose to replace ezisting boatlift and platform_20181002

JYCAMA / ❑ DREDGE& `FILL NO :72471
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ENERAL -PERMIT ��Previous permit 0,1 A c, D
} N16v ❑Modification ::, ,❑Complete,Reissue ❑Partial Reissue Date previous "permit issued
j r , 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
LK�gGles a ached.
Applicant Name - Project Location: County
Address Street Address/ State, Road/ Lot-#(s)
.,: City/�►^ �iv11 State �!/G ZIP
Phone # (0�/D ' S� E-Mail. /� Subdivision
Authorized A ent GiG/ilcLQ�S ' C CFI✓� % �� Ci l/•� ZIP
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,p Affected El CW ' ❑ EW PTA El
0 PTS -,Phone # River Basiri
❑ OEA - ❑ HHF ❑ IH ❑ UBA ❑ N/A n r�G nat ,man unkn f AEC(s): Adj. Wtr. Body //' /_ .
'❑ PWS:
Closest Maj. Wtr. Body 2/�
ORW: yes /�n� PNA , yes / no ,
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Agent or Appfi vg �inte`d Name
,
•- ? - �jgnatere.. -- * Please read co�mplian)ce sta a exit on back of permit
ApplicationFee(s) Check#

Authorized Agent ConsenjAgreement
herby autho " Tobias Jay Tetterton of
(Property Owners) )
TJ's Marine Construction, LLC to act on any behalf in obtaining CANA permits for
the location listed below.
PROPERTY ADDRESS:
101 E, w&*41 6�M0,t
1:�4 1 6 vee � 1,k- J, 7 g 1 p
PROPERTY OWNER'S MAILING ADDRESS:
r ant GVL- aZ?d3
Phone gym. // q —oZ/ D " 5009
l�r OPERT Y OWNER'S SIGNATURE
AUTHORIZED AGENT SIGNATURE
IDATE: a �� 20
WfAuthorized Agent Consent Agree.

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: !V.
Date: Ae
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)
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net revised: 02/03/10