63140_platform_20180906

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X 1 11CAMA / El DREDGE & FILL. NO'':.�%243 8 . /S
4r GENERAL- ' PERMIT Previous permit X/V . 41
,�y
_- I'�INew ❑Mod'ification - ❑Complete Reissue, - '❑Partial Reissue Date previous pernidissued_
i, 'As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in' an area of environm htal co cern pursuant to 15A NCACfP. d�®(
/ \ �� / �r� � es attached.
.Applicant Name in _ 1"GI/ 1 /1 / li l �/'� Project Location:: County ,
Address J 7 �Gi -11%' (% Street Address/ State Road/ Lot #(s)
City 11'n ��/` State i ZIP 1
Ga
Phone #AQ) �� E-Mail
Authorized Agent 6� - ibyc�lS
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ 0'
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no
PNA'- . yes
Subdivision' "AY
City (� ZIP
Phone # ( ) �— River Basin- 7X
Adj. Wtr. Body _ �/�C T G� �G na /m;
Closest Maj. Win Body k4c" �i;k-1,
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MENNOZONAMMEMENE
KMENEEMON■■■■■■. '■..■■
inted Name
_ Signature Fjle;
AppliS lion Fee(s)
on back of permit **
Check#

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to F air-wiu (mliyek Mot- P~ 's
(Name of Property Owner)
property located at Z Z/7 r! L V C62, e-#49 E -
(Address, Lot, Block, Road, etc.)
on Si L. r/e!L it, A K6 , in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
U,
WOO%1� il'i�G TC7 �E
,f,-GJ1j`on Lip")( 7-0
0 PdaPtl+�) 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.
(Pr e e nformation)
Signature
r-!z-4,uI,-Lr fJ A i Ne r2
P 'nt or Type Name
V 0 GOY- r 11-3
Mailing Address
City/Statemp
-z. s z_-- L(c) 2 5 3 q-7
Telephone Number/ email address
Date 8 J, j f 6_
Q5::;7=
Signature*
yo�� ,-���r�L1 S
Pyr,am
4e �oZ�
Mailing Address ,^ `
IDr_`y a Cc� C. o��l �ZO,
City/StatetMp
01
Telephone Number/email address
IC*NW'4- hor f- 09 P_''aPx'P' 1
Date* pro- 07 o � y
1 (Revised Aug. 2014)
*Valid for one calendar year after- signature"`

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to RMi-WO 184100k / lit- PIAVE 's
(Name of Property Owner)
property located at ?_q 7 S '/ C. VCP, t.4K1E
(Address, Lot, Block, Road, etc.)
on �'i Cyt,� i- A Kj , in oc- (-Aco X 6 , 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
0
LJco I.
;f'e otl f'OA y' 'A 7-0` -
�aE� CTMIw
WAIVER S�R�vi;ECTION PRoP��2�
I'oPZr+�► }
I understand that a pier, clock, 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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
V9'-e_
e information)
Signature
r-1ZAi t0_LJ P P. t 2A r,vi=
P ' Type Name
Tnt or Goy 1' z-3
Mailing Address _
0 C i0_ A C o K,C r tic. `2- 7 i 6 C)
City/StateMp
j/02 _ S3q -7
Telephone Number/email address
rl~+4 (2- 5-1�Azf1llnV-.Aek
Daie
*Valid for one calendar year after- signature*
L
a '�- 1<7 sO' CL ( -e--.
N g Address n< S)� I
r Yl e- 0 f `
Telephone Number/email address
Date's /
X12, � �0 f
(Revised Aug. 2014)

NC Division of Coastal Mgt.
\\Habitat Impact Computer Sheet
Applicant:�iilk�rl /�/k'S liilllJ °III
Date: %
General Permit #: •`7
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
tempimpacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge El Fill El Both El Other
d-��
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 ❑
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