63122_Bill Manning_20181002

CAMA / ❑DREDGE &'FILL •,-' --No' '72478 �' iJ..•,.
, GENERAL PERMIT Previous ermit,
: �- _ : P
' New, ❑Modiii6tio i ❑Complete_Reissue . ❑Partial' Reissue .Date previouspermit issued-
1.5:,'
f°.:. As authorized by'the State of North Carolina, Department of Environmental'Quality
r and'the Coastal Resources Commission in an area of -environmental concern pursuant to 15A NCAC
�' - .���f/�. •� _" , � - :: ules-attached. • .
Applicant Name /'/i�/jIir?l' C Project Location': County
'Ad dress . .� Street Address/ State Road/;Lot #(s) Q
b - h
City_ GJ' O �,ti, t- State.!(�G •ZIP c(-d-C,*'
Phone #�()r a,L7' / 'E-Mail" Subdivision D� �C-��, •y�,lJ((Oi G:.�
Authorized Agent
Affected ,` ❑ CW - ❑ EW " `PTA •❑ ES PITS
❑ OEA ❑ HWIF ❑ IH ❑'UBA ❑ N/A
AEC(s):
❑ PWS•
-,•ORW: yest/ no ' PNA- yes •/ ho
„ Type 1piroject/, Activityr��1c=
Pier (dock) length
Fixed Platform(i)
?, • Floating Platform(s) —
Finger pier(s) • r""'
Groin length
number,'
Bulkhead/ Riprap length
avg distance offshore
" - - max distance offshore
'Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
s Other
Shoheline Length
SAV: ' not sure, yes no
Moratorium:. n/a yes," no
Photos' t yes • /nod I
Waiver Attached:' yes no
A building permit'may be required. by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
,I
1 '
Agent okApric a t Pr'nted name
Signat:b a Pluease red compliance statement on back of permit
D6,Z_,)4�_
A plication Fee(s) :: Check #
City ZIP'-' -
Phone # ( ) River Basin
t
Adj. Wtr. Body (nat fman unkn).,
Closest Maj. Win Body
(Scale:
❑ See note on back'regarding River Basin rules.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
h hereby certify that I own property adjacent to C�r tC . 1�u.•.12 's
(Name of Property, Owner)
property located �� nud*-'r—
(Address, Lot, Block, Road, etc.) 11�
on h , in Tt U Cj'� �y N.C.
(Water ody) (City/Town and/or County)
The appli ant.has described to me, as shown below, the development proposed at the above
locatio .
I have no objection to this proposal.
I have objections to this. proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
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.)
t� I do wish to waive the 15' setback requirement.
I. do not wish to waive the 15'-setback requi
(Property Owner Information) (Adjo6ent r Iperty, ner Information)
AA It '`
11
SIN717ture Signatur
it,, V
Print or Typ rllame , Print or Type Nam
/D 7 l��r
M ' 'ng Address Mailing Address
Ci S ate/Zip ��a� City/State/Zip
Telepp/hone Numbe(/.\�J[J/j_grnail address Telephone Number/email address
/ !AFJ
Date" Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

NC Division of
Coastal Mgt. Habitat Impact Computer Sheet
Applicant: V111, G!
Date: vZ�`
General Permit #: �02�
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 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)
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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