71501A_Keith & Sarah Houff_20180517

71501
1 1
(�ICAMA / ❑ DREDGE & FILL NQ / 1 SO 1 0 B C D
GENERAL PERMIT Previous permit# �J
flew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality L /
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
/ lesattached
Applicant Name e_-. 4 ,- S w ra
Address 3.3 r<v 9 I
Ciry K.II Devi l fl; s State NC -ZIP 2_�??' b'
Phone#(�_qta) Y'L $ SYBY E-Mail
Authorized Agent
OCw
[�Ey
['PTA DES ❑PTS
Affected
AEC(s):
❑OEA
❑HHF
❑IH ❑USA ❑N/A
❑ PWS:
Ol
yes / (Io)
PNA
yes / Co
Project Location: County 'Du ra
Street Address/ State Road/<Lot #(a) �f /3
23-7 Lo
4 \ Vim(
Subdivision C.a 1-4+'x+ f)'o-Cy=v✓" jet
city/(�' I (II D /% llf ZIP 279'l�
Phone # (_) River Basin a s a 4 , 1<
Adj. Wtr. Body C a o ( (not /�an)unkm
Closest Mal. Wtr. Body
Type of Project/ ActivityLi
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Agent or Applicant rin Name
i" Signature "Pleaserealcompliaiice sttt ntonbackofpermit`*
42
Application Fee(s) C eck#
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Perch Otff/cer'x Prinud Name
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Issuing Date Expiration Date

AC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Keith & Sarah Houff
Dale: 05/17/18
Permit e: 71501A
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 im acts)
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 im acts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Open water
Dredge ❑ Fill ❑ Both ❑ Other ED
144
144
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill Cl 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 :: 1-888-41RCOAST :: www.nccoaatalmaoanx�ment net revised: 02103N0

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: J-Py °-S £. •, r-r
Address of Property`� t _LNc ` ,-E ��
. 0_
(Lot or Street #, street or Road, City & County)
i p r
Agent's Name #: SA-..+4 Mailing Address:
Agent's phone #: 33 ENT, -rC
540 -- 4y Y— s L4 1� It
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. Adescription or drawing, with dimensions, must be provided with this letter.
X i have no objections to this proposal. I have objections to this proposal.
If you have objections to what Is being proposed, you must notify the Division of Coastal
Management (DCMJ in writing within 10 days of receipt of this notice. Comespondence should be
mailed to 001 S. Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 2as-3901. No response Is considered the same as no objection if you have been
notified by Certi0ed Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat tamp, 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 musA sign 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)
Signature Signalla,e
R U%ii 1 : S i /�
Print or Type Name
SA, �14
Print or Type Name
Mailing Address Mailing Address
L � 22,7 w0 r9 P) E � I -kcait Gct ✓1�p Z 0 13

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