63369_Wayne Singleton_20181116

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GENERAL, PERMIT.' Previous permit,#
RN6w " EIMO'&fication' 0 Cbm, plete Reissue" El Partial Reissue -'Diteprevious permit -is-sued',`,.^
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 k�3 Rules attached.
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Applicant Nam Project Location: County T -5 --f-- k,1C4 f-, -;71 D
-'Address Street Aciclress/'State, Road/ Lot #(s)
State .0 ZIP LI,3:' -D
Phone,# . —T,/\,-
_5�2) ci '5- 33 50'E-MailSubdivision
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Authorized'Agent )k
Affected F1 CW , El EW, aPTA [I ES El PTS,,
O'OEA 0 HHF El 1H 0 UBA 0 N/A
AEC(s)-
0 PWS:
_0RW: yes /G, PNA yes
City ZIP
Phone# River Basin--t-A-L
Adj. Wtr. - Bod —i ZyL (—I (Qn�Rman lunkn:J
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Closest Mal. Wtr. Body
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Agent or Applicant Printed Name
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Signature '"Please read compliance statement on back of permit"
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':1 Check #
Application Fee(s)_
P mifOffilcer's Printed t<1arne
Signature
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Issuing Date Expiration Date

ACJACENT RiPAR1AN PR®PERTY OWNER STAT9 ENT
I hereby certify that I own property adjacent to
(Dame of P party ®caner)
property located at �L% � �d�ar/EGG �/C U�
(Address, Lot, Block, Road, etc.)
on r it 1i �U��ed ��'�� % , in. f, L3 R9 © ,1td.C.
(waterbody) (CitkiTown a dlor County)
The applicant has described to me, as shown below, the development proposed at the above
loc ti
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION s4NDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development mug t rill in description below or attach a site drawing)
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.
(Property owner Information)(Adjacent Properly weer Information)
in Sature
'
Si ature l ,,j141101
Print or Type Name Prtnt'or Typejv6me
Mailing Address ;Crit
i il' A re�ss /
UJRshT �,v �G, y/ J� fi �ol�
City/Sfate/Z+p QC( � ,41 �qo
a� 75 23a50
Telephone Numbe /email addresZS l � ���`� Telep0ne dumber email ad e ss
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to V 1i ►' • is
10 (Name of Pr perty O )
property located at CLY � f- Vim.
(Add s, Lo Elock, Roa ,etc
on �' , in , N.C.
(Waterbody) (C1tyAt9wnand1or County)
The applicant has described to me, as shown below, the development proposed at the above
to do .
ave no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
lndiii diiah04osing:clevelop►ner w.,or attach'a4s to drawing)
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.
(Property Owner Information)
(Adjacent Property Owner Information)
Si
Print or Type Name
Mafflng,AMre 1 v C Z% �
City/state2ip
Z S zL7 Zs� o
Telephone Number/email address
/ /-- /N-14
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

Applicant: y,�A+29#4ALL. U,/ 51rJ44,C-r,04
Date:
General Permit #:- 7Z 4t.91_5 '
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft
FINAL Sq. Ft
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance. -
Habitat blame
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration andlor
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
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Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill [I Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑