63369_bulkhead_20181116

FUt .. 1�dLAMA / ❑DREDGE.& FILL,, NO. '72491 - • A C p
c GENERAL- PERMIT Previous. permit#
' ClNew ' ❑Modification' ❑Complete" Reissue ❑Partial Reissue Date previous permit issued 1
As authorized by the State of North Carol ina,:Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC, - ' k 00 • -
/0 rk� S Fd A—L- Q Rules attached.
Applicant Name �JA S r�}Project Location: County 17S ✓I; ` -�1 .i ' �O ... ' '
- Address Street Address/,State Road/ Lot #(s) ,
City L,) (A � l'vt ��I State +- ZIP q 3 -T-A
Phone # (Z 5t2)'q -) s - 335-DE-Mail
Authorized Agent A'�`�—
Affected ElCW , ❑ EW. PTA ElES El PTS `
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
ORW: yes ,ono PNA yes
Subdivision -T/\,L.�-1
City ZIP `c5
Phone # '( ) River Basin-tA Z.- ?n�n L < n
Adj. Wtr. Body--t t'--1 Vt-�YC_ c(nat man /unkn)
Closest Maj. Wtr. Body
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MINNIE
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Agent or Applicant Printed Name
Signature " "Please read compliance statement on back of permit"
Application Fee(s) Check #
Pelmif0(ficer's PrName . ��-
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Signatur �-
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OINNER STATEMENT
I hereby certify that I own property adjacent to ,q1 � SZs
(lame of Prbperty Owner)
.. properly Located at Zy
(Address, L®$, Sloc6c, Road, etc.)
On 1l 1I! P/ll�l/'G e�•� ��^�� % , in. R9 6AJ N.C.
,l laterbody) 7—� (ClltrTown a dlor County)
The applicant has described to me, as shown below, the development proposed at the above
!oc ti
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site draw%g)
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 weer Information)
rn --
S' ature
Print or Type Name 2'ntpr Ty�pee ►ame
Mailing Address M it fi A re /
City/State/Zip City/Stateal �
J �� 975-33 /I'I S iJ G-/e J608 L; — h o 0, cvt�
Telephone Numbe /email addressSa'�1VwXd TelepO ne Number email address
Date
Date* T —
(Revised Aug. 2014)
*valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 2 I
(Nara® of Pr perty O )
property located at Q Y 2� f I i/7
(Add s, Lo Elock,Roa ; etc
on �'K, in , N.C.
(Waterbody) (CityAt andlor 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
.hdiw�fual ' ►o os®a°,`aevel®� rtenf-'i►aust���I/.�n.:clesc�6 ti®n��b�%sDwo� aitacli�e�steclr."aMiin--
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.)
1 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)
LU
Si nature Si e Uf
MA�n S
Prin r Type Name Print or Type Name
ail"Mailing dre .��C � n /C z 7 �
046/Stat ip _0 City/SttatlZip
.2-2-7 ZS�o .
Teleph ne Number% mail add s Telephone Number/emGail address
1q_I p
Date Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature'

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Applicant: y,�A�S,.jALL Lr/. 51?J4GE•Tz-3hl
Date: / & J�oy�Mf3 Zv 1
General Permit #. 7Z
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 Sy. FL
FINAL Sq. Ft
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
• (Applied for.
(Anticipated final
Habitat Name
DISTURB TYPE
Choose One
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp Impacts)
impact amount)
teino im ads
amount
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