71234A_Dennis Anderson_20190129

CAMA / ❑ DREDGE & FILL No 71234 B C D
GENERAL PERMIT Previous permit#
t 1New El Modification ❑Complete Reissue El Partial Reissue 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 I SA NCAC `V(J
I] Rules attached.
Applicant Name :,r� f1��wrSw� Project Location: County C- v - I
Address S 6,;� O 0-0 o VA,.— J Street Address/ State Road/ Lot #(s) a p L4 S . t uo �+ / j, w r J
City t-. State i—, L ZIP
Phone # (�) q8a !o llii E-Mail
Authorized Agent
Affected ❑ eW ) EW [,X PTA p ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Subdivision --
City iu r u k ZIP 9 aT
Phone # ( ) River Basin O
Adj. Wtr. Body Cyr r -, ct man /unkn)
Closest Maj. Wtr. Body rA
Type of Project/ Activity { ,, g,, t1C I. e 1 a„n r 4 i .. G 1 S 1 r I iu -1 "T w n a D* a i e^ 1
(Scale: = L( 0 )
Pier Me
Fixes
Float
Finge
Groii
Basir
Boat
Boat
Beac
Othc
Shor
SAV
Mor
Phot
Wain
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
ng Platform(s)
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r pier(s)
7 k
i length
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number
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EMME
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avg distance offshore
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max distance offshore- W
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Boom
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NONE
cubic yards
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ramp
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-i Bulldozing_
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notsure yes
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A building permit may be required by: �. ,, v G %.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
l^
Agent or Applicant Printed N
Signature **Please read compliance statement on back of permit"
-4
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
Permit 0 anted Name
Sign 9 Fure
I IAA 14019 s1a41 �afg
Issuing Date Expiration Date

NC Division of Coastai Mgt. Habitat Impact Computer Sheet
Applicant: �'+ 28 `5� i
Date:
Permit #: :7 P1,3LI11f,
Describe beidV 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
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Shoirt A.L
Dredge ❑ Fill Both ❑ Other ❑
a 33
1;1 -
Dredge ❑ Fill ❑ Both ❑ Other
'1 v
t-t(00
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 ❑
252-808-2803 :: 1-388-4RCOAST :: www.nccoastalmananement.net revised: 02/03/10

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �e+nn'ts 4A--e%/`CVk is
(Name of Property Owner)
property located at vLO(} So,.Ayk -Avo• () � )—eA
(Lot, Block, Road, etc.)
on Cy ✓` '1+y c� Gv mA , in _ co-ilixko c� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone 6 Mailing Address: /O to P 4eo can,- c4
and� (?C
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/ORpRAWING OF PROPOSED DEVELOPMENT:
S •`'r'r'^ 4-(To be filled in b property owner proposing development)
� a)C34-
(Information for Property Owner Applying (Riparian Property Owner Inflation)
for Permit) n \ \
Mailing Address
Cow Cz VAC D--)'i 2-3
City/S to/Zip
Telephone be
ignature D to
v Signature
PrInt or Type Name
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 44 is
(Name of Property Owner)
property located at
CA-,) --/� lI
(Lot, Block, Road, etc.)
on�JV` GC`Vv�a� C.,:b t L, N.C.
(Waterbody) (Town d/or County)
Applicant's phone #: ZS-2`202-10926 Mailing Address: /0 6) P,1,1-
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/ORpRAWING OF PROPOSED DEVELOPMENT:
y • •�t`'wr'^ To be filled in b property owner proposing development)
�P! .k -.S u
(Information for Property Owner Applying
for Permit) rr
-2C3 C( Ci • � � , l l t �t
Mailing Address
C-04 o cic 6 1C cr - 3
City/Stat /Zip
2sz- q437Z - 0 r(
\ `t-,6L^
V
(Riparian Property Owner Information)
t L Signature
pr �Vie LLC
Print or Type Name
x 5 � SJ') -3 rz.Z
Telephone Number Telephone Number
� a x J
- '
pature Date f Date

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