63387_Propose to drive four pilings to create 1 wet slip_20181108

"CAMA / ,]bREDGE' &" FILL
�
w; G,�{�ENERAL., P_ ERM.IT Prev�o�spermit#,i1��A
k AeW OModifcation EIComplete Reissue " l]Partial Reissue Date previous permit,issued'A;w
As authorized by the State'of, North -Carolina, Department of Environmental Quality, (�
and the Coastal -Resources Commission in an area of envirohmental concern pursuant to 15A NCAC'-// • /Q�'''
1 Cul'les a ched.
Applicant Name /per 1 x Project Location: County -
Address / le - Street Address/ State Road/
/Lot #(s)
s City r i State�ZIP-�� (
Phone # (oj��'"T �.•�-Mail Subdivision . _
Authorized Agent /�D���G I'c�/iKr'v City ZIP ���
❑ 64 �{EW kPTA_ ❑ Es ❑ PTS Phone # ( ) River Basin:
Affected _ ' T11 . . - - •
AEC(s): i
❑ OEA ❑ HHF ElIH ElUBA ❑ N/A
Adj. Wtr. Body � /!� S ��� (nat /man /unkn)
i .. ❑ PWs:
ORW: ' yes / no PNA yes no Closest Maj. Wtr. Body
iawl
1111 1�-
■■■■■■■c�■■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■
:�C■ :■::::
■■EMOMMEME MEN 0 EM■■C■■
■®■■■■■■�■fie
■■■■■ ■■■■ ■■■■■■■■■■■■■■
. . ■■. NRWI
■GCS;��:■■..■■■■■■■■■■:�■■.■■_.moo..■■
■..■... .....�.... ..■it
Agent or Applicant Printed Name
Signature Please rea, atementon back of permit
A 01,41
Ap p on Fee(s) " Check #
Permit Officer'ssPrinted-Name'
Signature
Issuing Date, Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I- hereby certify that I own property adjacent to 's
I I (Name of Property, Owner)
property located at /Ga 2/.✓�/C �.V
� (Address, Lot, Block, Road, etc.)
on IL)6 ?7f �'�R��J� , in , � , N.C.
(Waterbody) (City/Town and/or Coun )
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 ANWOR DRAWING OF PROPOSED DEVELOPMENT
;(?
{+[..tg l.�.!- .�. r,J; q?.iy '.Cg i,.. ✓iT..ke. °.d.t.P.;1. a.t .#ji,iJJ lhti£f.l._-4=A;� �fa4
75
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.
. I do not wish to waive the 15'-setback requirement.
(Prop Owner Information)_
Sign
Prinj or Type Name
CYJ �i'�►/iG/� �.J
Mailil g Address
City/StatelZip
Telephone Number/email address
/ /-7-- / 0 -
Date
(Adjacent Property Owner Information)
1. -&- o....�. �;aw-
Signature *
Print or Type Name,
V L
Maili g Address d►
City/State&*
tea,-q��,��
Telephone Number/email address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
t hereby certify that I own property adjacent to S774a2 <z5 �✓�L-mac 's
(Name of Property Owner).
property located at /,a-i Z 1,,4WrE
I (Address, Lot, Block, Road, etc.)
on No/Z77¢ - , in C ^i1xjT `% , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
i� I have no objection to this proposal.
I have objections to this proposal.
,;3..�e..x_t
®'
WAIVER SECTION
I understand that Ipier, Ick, 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.
I do not wish to waive the 15'-setback requirement.
(Property Owner Information)
Signature
Print or Type Name
A50 -:--, r'J
MaiIIA—� sus
CitylSState/Zip4
Telephone Number/e ail address
//— y 17
Date
(Adjacent Property Owner Information)
4 5z _ % , Y/ �I-/fi
Telephone Num a /email a dress
r -� � LS'
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
r/'9n
Date: i
General Permit #: -✓3
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.nccoastaimanagement.net revised:02103110