63894_Meliss Thomas_20190228

7151
DREDGE. &FILL,_ 7_ 6 :72989
A C_ k",
-revipus permit
PERMIT V ERAL:, T -
'EN
Date ; previous permit issued ,
iion lkompl6te Reissue,
i
ifica Eipa,rtaeissue
_CaroI4:ia,'Pepartment''6fEnvironmentalQuality.
As authorizedthe-St e of North I
and the Coastal,Resources Commission in an area of environmental concern pursuant,to -1 5A NCAC 01 44
Mules attached.
Applicant Name 1/)/ -1 4r>AA Ci S Project Location: 'County'
Street Address/ State Road/. ot
Address.:.)-- 2>P-,yV s) Z5FF- -J J-
State
C1 ZIP <9'1 �A- -Y.'V i a
'Phone 1 It' - M ai I
Subdivision
Authorized'Agent 6 /-1 r8t-, 4-G7- CityfzACT14-
AffectedECW gEW .,5PTA, NES PTS. Phone River Basin lT-7 RA M W e Z
0 OEA El HHF El 1H El UBA N/A
AEC(s): Adj. Wtr. Body P-W L. i -,.C> 17'1)-L1 ((naa %man /unkn)
El IPWS:
P A, 0 L'I
Closest Maj. Wtr. Body
ORW: - yes no PNA yes
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MOMMEN■MEMEMEMEM
0, n V, H:,_5* a )9 0 Irl rli�?
lqeat ,ajAp 'icant anted Name
As)k'nature Please 61 reGd1compliance statement on back of permit 1 read;
compliance
Fee(s) Check #
L;L X �O
Permit Officer's Printed Name
Signatur6-N
Issuing Date Expiration Date

Authorized Age
70
(proper
'
Tj,s Viwwee to nstjuction,,LLC to act on-i
the b cation listed bel6W.
'PROPERTY
u
A)
-PROPERTY OWNER'S. MAILING
4 '3.
Phone No. /7
PROP
ERTY
AUTHORIZED AGENT SIGNATURE:
DATE-.-,-�'�.
�i 2® ��
WlAuth&iied Agenf Cohsent. Agrec.
ConseittAgreement
4
**.Pw4An Af f,
talf in -obtaini I fig ,LAMA.-P eirwit* for.

r
1li.1�GEi� i�➢��1 ti��P�
i heby soft fiat f &*Property adjacant to
i prepq* focated 'st . gg dJJ
r f4�6di�g, L5
an
(atarbody)
The applicant has -described to me, as shown be
loca�o ..
Adis f have no objection to this proposal.
f have objections to this proposal.
�'►ii'� :"f r U.C.
(C➢tylTown andlor County)
the development proposed at the above
Rv—SECTION
l understand that a pier, dock, mooring piiings, boat ramp, breakwater, boathouse, I!% or groin
5W,_� must -be set back a minimum disfiance,of IIP from my area of riparian access unless waived by
wN me. Of you wish to waive the setback, you met 1nW61 the appropriate blank below.)
— l do wish to waive the) 5' setback requlent.
1 do ndt wish to waive -the 15' setback requiirementL
1
(Pf0ParW 00eir Info naation) ('Adiacent" Oronery Owner WhrmaRinni
`Valid for one calendar year after signature*
;saatuY- by • TCA pi
inior•Type, Name
M) 9AU`��
Wing Address 9
UC
y/Staie/Zip
Leo • •�dm3 hIV-an . Fetf"a4iW_*
fephone Nyr abar/emafladdress' faLEI
(Revised Aug 2014)

. TY • ER.-S-TATEtt1lENT
that i cm*auur� PmA� adjacent
. i hereby c
_ _ s
A upeny -located at e PPOi° tit eer}
,�
an /�Ca ,.;*(�i"' , its r- N.C.e�efb�d�t} j JCIbII�'own andIbr County) .
The applicant has described to me, as shown below the develop
locationment proposed a# the above
.
Miarg�j- 1 have no objection tv this proposal.
o�r�2r 1 have objections to this proposal.
Ile
r'..q.---=.t YVMV�K UMUI
Fop= : ' I understand that a pier, dock, mooring pilings, boat
must be set rack a minimum distance of 15' from ml
�= me. (If you wish to waive the setback, you M1 t
MItle
w,
1-do wish to waive the 15' setback requir
I do not wish to waive the 9 5' setback n
(Pro owner 9nfon- n, Man)
�sate;ofra�ri�a,
oIk/re4l-1
ramp, breakwater, boathouse, lift, or groin
area of 'riparian access unless waived by
I the appropriate blank below_)
amens
quirement
Wj cent property Owner.Infon anion)
6
IM
�,Cenro in{t
=Valid for one calendar year after signature {Revised Aqg. 201J

Applicant:./1�1, A- 5
Date: 2 ,V
General Permit #. 7 Zgg ,
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. FL
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp im ads)
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
teim impacts)
FINAL Feet '
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
rJ57
Dredge ❑ Fill ❑ Both ❑ Otherfij
4p
Dredge ❑ Fill ❑ Both ❑ Other
y�-TFa-LLo tsi
672,-nt
_
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 ❑