71294A_Edward & Diana Hall_20181206

aJCAMA / i40REDGE & FILL
ENERAL PERMIT
New ❑Modification ❑Complete Reissue ❑Partial Reissue
N2 71294 Q B C D
Previous permit #
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
TT // ^ DMIesattached.
Applicant Name Ed ay J4 J7, n r. Fi r^ �/ Project Location: County
Address / a/ i 5 / k �. d �d M .''I,II T o r. Street Address/ State Road/ Lot #(s) Z �'f 7 3 T 2 `j
city/)'lzc ho.,l,Jv-/� State�ZlP %3//(a, _1YG 5,,.Iv. e,4 Dr.
Phone # (10�jj iS " E-Mail — Subdivision C o I n • i�> /'/ o r!y a ! Se >vl
Authorized Agent m a r-i t d C✓ o r x r" City V, // DQ v l : 115 ZIP A2 -77`/ 9Affected I
El,
VIEW ZPTA [ffES I5PTS Phone # ( ) River Basin A4 Sd � �+ /ti
AEC(s 001M ❑HHF ❑IH ❑UBA El N/A Adj. Wtr. Body C anr. � (net m
ElPWS:
ORW: yes / (o-) PNA yes / no, Closest Maj. Wtc Body 14 �6" it -f `j
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Agent or Applicant Prin`tee'd� N�anne
Signa�*'Please read compliance statement back ofpermitu
¢)I/ �_ ,, 1>0153?3Y/
Application Fee(s) Check#
Perini ORcds Printed Name
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Si ature
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Issuing Date Expirationlssuing Date &piration ate

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Edward 8 Diana Hall Permit #: 71294A
Date: 1216118
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 tool
includes any
anticipated
restoration or
tame impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feel
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feel
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Shallow bottom
Dredge ❑ Fill ® Both ❑ Other ❑
150
150
Shoreline
Dredge ❑ Fill ® Both ❑ Other ❑
75
75
High ground
Dredge ❑ Fill ❑ Both ❑ Other ®
1500
1500
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 :: b88841RCOA5T :: www.nccoastalma oment.net revised: 02MI10

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �-C--Iw d IAII
Mailing Address: '3616 r(CQ-dll (,6&j pVIY(f�
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for andobtainingall CAMA permits
necessary for the following proposed development: Q0Oboe
at my property located at �30& `S L n*l ao �YI ye.
in —ffiCounty.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:'/y,
ie , 6
Signature
Print or Type Name
/ -;2 % /20t'6
Date
This certification is valid through
Revised Mar. 2016

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that l own property adjacent to eolfllgj 9(( 'a
���_,J ,�''` (Name of Property Owner) �v
property located at %IIX�IUU1�l(W �(N� V i I I 0�IIIIf (11�
.�Q j� Address, Lot, Block, Road, etc.)
I��z.-c�.Vl Icr , in j� (�I )�.1���rI�S �i2 i�-L'n1LVrk.1, N.C.
'-'(Waterbody) (town and/or County) —)
He has described to me as shown in the attached application and project drawing($), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Fd
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140�C%1�
Print or Type Name
-2;:?6-c507
Telephone Number
l�
ate

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby eenay that I own pmPedy adiaosH to axod Liall is
' (/,, (Hama of P,ro/perty Owner)
propertybeated3'7 t1 at r myl' w Delve Ki��l�✓�_I_ itLLs�"�—
Add.., tot, 81.0, Road, ato.)
on L� In ll.II&V1�W1��S
(WHarbody) (town and/or C.
He has described to me ea shown In the aaachad application and project dmwhg(s), the development
he is proposing at that locsticn, and, I have no objections to his proposal.
hI'll llt0JcaLlCl:e:,:r._ —_ _ _e _ a - - e
Signature
P II S
P ntur Type
n, .>• i :�-/
Telephone Number
Date 6�Y

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D. O'STEEN, P.E.
qOUNDVIEWDRIVEMICHAEL
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