63727_Breht Roberson_20190208

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- A 'CGENERAL PERMIT Prpylouspermit,
New iM6ciiication,_,_L6om 1eteeissue 0Pa�tialReissue Date
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Aiuthritdcbythe Stat:6'of North Ca79I-n"a,� Departme
nt cErvrofimental'Qualiy
andthe-Coastal Res6urces Commission in an area of environmental concern pOrsuantto I SA NCAC,- 5Z Rules attached.
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Applicant Name .12, Projecttocation: Coun
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Agent or Applic t P ' ted N ame
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Signature. "Please read compliance statement on back of permit"
VJ A 1 c,-Y9
Application Fee(s)" Check#
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if Tficer's P ,�Fint6d Name J
SignatuilecL_')
Issuing Date • Expiration Date

ADJACENT RIPARIANPROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ',6rtrrf - Rio be rs a r) 's
�1 (Name of Property Owner)
property located at I I �J uQ V Ros2cff
on Pamlico River dress, Lot, Block, Road, etc.)
in && , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
Z_ I have no objection to this proposal.
I have objections to this proposal.
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.)
AVP 'V 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)
S1 ature Si' gt�r
tr� n+ Raherao n R gnre gt �� &0wr%
Name,
Number/email address
"Valid for one calendar year after signature'
runt or i YPA Name
p. 0. 40Y.- f10
nn jn9%.1,0 g
C/S ate/zip
o,-6A-4—gr5.s
Telephone Number/email address
-�)/I /19
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ate '--
(Revised Aug. k14)

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Applicant: r'Fj'2-�T �p� wry S ocJ
Date: a6
•General Permit #
^? Z Ql `+- °l
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 Sq. FL
FINAL Sq.-Ft
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied W.
(Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and%r
restoration or
and/or temp
restoration or
temp impact
temP impacts) )
impact amount)
temp impacts)
amount
Dredge ❑ Fill ❑ Both, ❑ Other 150
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Dredge El Fill[IBoth [I Other
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Doge ❑ Fill Both ❑ Other ❑
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Dredge ❑ Fill ❑ Both ❑ Othe?-I-
Dredge[] Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ FII ❑ 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 ❑