63385_Propose to constuct a 12 x 20 boatramp_20181115

LAMA / DREDGE -&,FILL' No. 72903
i GENERAL PERM IT'-, Previous permit
New- ElModificatioh OCornplete 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 15A NCAC/y �.3G
IWX�ules ttached.
Applicant'[ %� / ✓1� -� Project Location: County'Gi'U'"o(��
Address�� r� (�(� r/ /��i Street Address/ State oad/ Lot`#(s)
City 64244: _ State/ ZIP %�% .C�i/'�� �. '�/C��-•
;Phone-#t�) E-Mail Subdivision ,
Authorized Agent% City. ZIP
Affected ❑ CW )(EW PTA LiES ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ,
AEC(s): Adj. Wtr. Body(nat:Nman unkn)' .
❑ PWS:
ORW: yes / E PNA (yes)no Closest Maj. Wtr. Body�.�•
Type of Project/ Activity
Pier (dock len th
Fixe
Float
Fing
Groi
Bulk
Basil
Boat
Boat
Beac
Oth,
Shor
SAV
Mor
Phoi
Wain
.(Scale:© )
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MENNEENNEENEEN
NONE
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ramp. zz,
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--r Attached: Yes,-.
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A building permit may be required by: ,See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions S«'
1��X flAlI
Agent or. Applicant Printed Name Permit ffcer 5 P inted,Name g2
Signature Please read compliancestate'rimenton backof permit" ign ture
A/p lication Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
ne of Property Owner)
�3G -9- /_V/99
's
(Address, Lot, Block, Road, etc.)
on A)Drll e r&& k . in RaA j )C_ to e r l a -For 60401U . 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 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
Axis �rar"re lsu�
i E- uldih
-Ramp
AI
tla�
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 16 setback requirement.
Sign ture '
14 nsvn
Print or Type Name
i('�y A"S'5g t V
Ma%ng Addre Z rd tJ-2 dt,G
City/Sfate�lip .
�1 -y44- �a�a
Telephone Number
//-/c5 -/Y -,be
Date
(Adjacent Property Owner Information)
Signature _
Print or Type Name
In-7 r t,\ ip ip u- 17-- f,v
Mailing Address
irk 7 �C)
City/Stat ip
7.t;7-wU"7 - J7s,:L1
Telephone umber
Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at 110, (Tr Y'V'Pt-
(Address,
on roAf e]-P (;uf - No W Crex-e— , in.
(Waterbody)
and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
IJ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing) ,
A"6400 Pier.-katmi
U
Houses
5 Dri Ve "u
r
WAIVER SECTION
I ,understand that a pier, dock, _mooring 'pilings, 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 re irement.
Owner Information) (eRt Property Owner Information)
Signature Si at re
O
Print or Type Name Pn or TypeN
M 'lingA dressl 3� �d Mr�ls
City/State/Zi QtYZStatq1zip ;
Telephone Number Teleph7e Number
Date Date
V
(Revised 611812012)

NC Division of Coastal -Mgt. Habitat Impact Computer Sheet
Applicant:
Date: `� ��� saki'
General Permit #:a�/W 7,2
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
447m,
Dredge ❑ FillA Both ❑ Other ❑
o
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 ❑
_7
Dredge ❑ Fill ❑ Both ❑ Other ❑
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