63698_Tim Struchen & Dera Alderman_20190211

'RE & �D10�(09B Q,
... N 70656,._. C D
GEN ERA-DDGE FILL
L ' P.ERM IT Previous permit #
L New. - - ❑Modification (Complete Reissue El Partial Reissue Date previous -permit is ued- N 4 --
JJ f.. B
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 07 k). Z '4 0 D , , -
ules attached.
Applicant Name -VA yi(il IZNFA% d DfI.� i�C!)lrl Project Location: County
Address 7� g j �� F�Yh►G �/I� j2p Street Address/ State Road/ Lot #(s) N(]. of
City COUAMYJA State- J& ZIP 77,1 - ,rP—Yln)()194tJ IZ�_
-91
Phone # () �i� OWS E-Mail Subdivision 1 jZylnl r; yA/J
Authorized Agent
❑ CW
❑ EW . Lid'RTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF 111H. ❑ UBA ❑ IV/A
❑ PWS:
ORW: yes no.
PNA yes / no
City CdL (Am ZIP .2
Phone # ( ) Riv r Basin F/)-5d V
Adj: Wtr.-Body Fly iG � nat /man /unkn)
Closest Maj.- Wtr. Body IV'.'(,APX
r
Type of Project/ Activity'AIA7)l Oi?,I !sd WMAfJ17 kjfp-Ap �XV flj lr,—df
(Scale:
Pier le
Fixei
Float
Fingi
Groi
Bulkl
Basir
Boat
Boat
Beac
Oth+
Shor
SAV
Mor
Phoi
Wain
RIM
w■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
i length
■■iii■a■■ieiii�r�ii■�e�ii■■e■■■i®i■iii�■
■■■■■■■■s■■■■r��■■■■■■■■■■■■■■■■■■■■■■■e
ii■■■■i■i■ii■i■■ii■iiie■■iii■■i■■�■i�■■■
avg distance offshore
max distance offshore
■■■■■■■■■■■t■■■■■■E�t15►iilJR,l71bf/�l�1►>a■■■■■■■■■■
channel
cubic yards
■■■■■■■■■■r•�a■■■e�=�-•�■■■■■■■■■■■■■■■■■
ramp
■■►■■■■■■■,■■■■■■m�■■■■r�■■■■■■■■■■■■
■■■■■■■�i■■��,■w■■■■■■■■■■■■�■■■■ems■■■■■■■
Bulldozing
■■■lNONE
\■■■■■i1i►a■■■■�1■■■i�ih�■■i■i■■■■■■■
1
■■���■■lr■<11
i>7■■■■■ii�■■■■�■■■■■ram■■■�5�■■■
■���fl■■I�i■tall■■■■■■■■■■Ci!/J■■■!�■■■■■ice■■■■■■
■1511��1■\i'■■L';i-Iti■■■■■ice■■■■■■■■■■r'll�tii��r"C�i■■■
line Length
notsure no
iii�itl■■il■■t!1/!�I[f�i■■■■■■■■�'if��i■■■fS.�J■■■■■
yes
�i■■■l\■■■■■I.111
I:■
■■■■■■■■■■■■■■■■1■■■■■■■■
,A building permit may be required by: I l K?—CLL- -OIAA 1 ' ❑ See note -on back regarding River. asin,rules.
( Note Local Planning jurisdiction)
Nofe`s/ SCons S"( . ��/j 1pO i-
of 900)? `r1o7- KxcE69 6 (PAnLRwAIZn .A)U)L•-g(FIZAr' AJoi P - gE Sm>�CY
�Q
b Ghr•a- 1VeV I'J OVO
Agent or Applicant Printed Name PermitOfficer's rinted Name
Signature , ** Please read compliance statement on back of permit" Signature
- � 0o;'ra0 31 Y� j°I.:.� f c v• and
Application Fee(s) Check# Issuirig;Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T� W\ �I %� C-3CJ'L t--Yl 's
prc
on
The' applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
j 6 -6 r)
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' .setback requirement.
ez
.r
p
t
rr
(Property Owner Information) ( 'acent P erg Owner Information)
Suture Signature *A, n d /c(
I t Y✓t '5 17%Xc-)-,I—. nJe., a .Sir to LvCr
Print or Type ame Print or Type Name
Mailing Ad�ress !U J Mailing Address
1�a, c Mr, Ile— t� J s 600:5h. I)17-)"nn A/G.o9l
City/St e/Zip City/StatelZio-J
5(->,r(it%�//�•ht�
Telephone Number/email address Telephone Number/email address
is7<Q-e2�v=s�co a�s��y�,s� I
Date Date*�
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �- rv\ , 1'7—ID. ra r k zy7 Is
property located at / � (Name of Property, Owner)
- y 4.'k)
(AdBress, Lot, Block, oad, etc.)
on aC in �a
S?►.1 � ��l ,
�body) (CitN.C.
ylTown and or
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
}�' i ! .S 'R "' i y .i-.•its.. yJ1.' • - • - • 1 •
2
�x"J27Jaf.P��'��l!"l771�fio�i
Z-Pe—
Ta> 45r7c5 zr,5 !l/
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner In (Adjacent Property Owner Information)
1-00
Srtature Si ature
1 t r✓t S'!?� CJ,QSraee `-
Print or Typ ame '
P nt or Type Name
Mailing Ad rd sss� Mailing Address /1
99�61—emafl
City/State/Zip
address Telephon Nurpberlemail address
13 ,A®1aa/9" 1�
Date
Date
*Valid for one calendar year after signature" (Revised Aug. 2014)

Applicant �/t1 T %Zu r G HFn� f D ou
Date: P F C Z D I
-General Permit #: 7
,4CDCP-r" Ar✓
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/ortemp
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
VA LU W- Bn.,
Dredge ❑ FillPf--Both ❑ Other ❑
gooFT"z
U0FT�"
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0--
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 ❑
WE