63869_Earl Pugh_20190212

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DREDGE:& -Nd FILL-.-,
L PERMI
,8EN`z,EHA :Previous,permit #
'plete 11 NrtW, 116issuie rmit,
Date -previous' permit issued
As auth�orked:bythe State of,Nori:h C_a�61ir�, De artment:of
`.'ity
andthe C6 alResourceoCommission nn area -of e6virohmenf�l'conceipPdrs6ant to I 5A tAC'
R U
lZeattac hed.:
4 r ProetLocaiion�`ouny C
• .APHCant Namez�jC
AddressStreet, 12A
�irebt Addr ss', ateRoad/ Lot _#(s) ' City "A - 4�t I P 'p. FOW Stite
Subdivision_
-Mai I
Phone 01-2l _7 E
A orized-Ago ut . h -nt' 6-ty-
asin
Wfected- 0CW1 -XF7A TS Phone ' River 9' !fir y
OEA 0 HHF 01H 0 UBA El N/A
AEC(s): Adj. YVtr. Body 16
El 01main /u'n`k'n)
El PWS:
Closest Mai. Win Body'
ORW: * yes PNA , es /no
Type of P roject/ A '(Scale: A2
Pier
Fixe
Float
A
nft
Groff
'Bulk
Basin
Boat
Boat
Beac
Oth,-
Shoi
SA)v
Mor
Phol
Wai,
MEN'
IF=-
W
r pier(s)
length
number
ead/ Riprap length
avg distan-ce offshore
max distance offskore
h
ON
MEN
EMNWIZAAWANUM
ENIMEWT117JIM22
�bi
1107
c
MEN
ra mp
�,ouse/
Boatlift
MEN
NOME
MMMNMMMMw=NM
■■■■■■■'■■■■�■
h Bulldozing
r
ENO
■■■■■■■■■■■■■■■■■w■■■■w■■■■■■■■w■�■■■■
dine Length
no
notsure yes
■■■_■■■■■■■■w■wwii■w■ii�
wii■■■w�■wiii■
torium: n/a es no
als:
er&-ra6ed:
A building permit may be required by:
Note Local Planning jurisdiction)
0 Notes/ Special Condi ions
-ro-2,12,
e—
Agent or AVpp�qan Inted Nam
7/2
; S* natu e ?** Pie rii�atj4orfipliance statement on back of permit
pplicati Fee(s Check#
A
See note on back regarding River Basin rules.
2
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Perm
YPrin 7�Nea,
Signature
Issuing Date Expiration Date-

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �a r 9i R '9 J I
(Name of Property Owner)
property located at 3.1-59 N o,b r`a1�G F ne-(�•v� - 1J C
(gddress, Lot, Block, Road, etc.)
on aS 1; C in Cris ( Ve,rgl , N.C.
(Waterbody) (City/Town and/or County)
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
flndividual proposing development must fill in description below or attach a site -drawing)
Cl e �h �e.A s ,,,, Qv,,- 4
-rC6 ,, 41qe- Car.ck (
Joxe affiACt--,a.1. M %
WAIVER SECTION
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.)
- EnVys I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Ow er Information)
Signature L Fa,r 1 �• Qivtit^ U� t
Print or Type Name
U a r-b
Marlin Address
ntielh.,rc► WC- 2782.H
City/State ip
25z - 473
Telephone Number/email address
2 - 11 - 2.0 11
Date
(Adjacent Property Owner Information)
L1— Il
S* Cenat)ure
r / �L✓Sor� ti o
Print or Type Name
ro?S2���%3 S198� ./�9.��L�('BL ��r�r.d'�96�a��.<d�•�.
Telephone Number/email address
/'I J /f
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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ThQ.,,app[lqqnt-:ha w q-,Oqsc(ibe .to In.pr,,,ps shown below. the-OpvoloP ment, proposed tit -the abdVO
thave o0jgdons tolhb!proposoli-
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I und.emtomid rift.,
must_ -
he, get hack = qL rn im .0 c f,,r
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C Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: iG, i I lei
4
Date: a /'Lj,,-it/ 2,o / J
General Permit #:
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. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge [ Fill ❑ Both ❑ Other ❑
l�
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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