63833_Gordon Ray Sumerlin_20190305

LAMA / ❑DREDGE &FILL
A., ��.
,GE'N❑ERAL PERMIT
XNew Modification ❑Complete Reissue ..Partial Reissue
ii. As authorized by the.State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmentallccdncern pursuant to 15A NCAC
Applicant Name- ����i'► =Gi �' w/r�l "`/ Project Location: County
Address 0 A".1 X Street Address/ State- Road/ Lot #(s)-
Ci l %li/y' State�64 ZIP 60 /
No.-:72974 ����- -
CB " C D
..Previous permit # 4
Date previous permit issued /W,
,® Mules attached.
Phone #UO "�31 'n �a E-Mail Subdivision
Authorized Agent `�, %�l. T/lJ��//� % City I �C� ZIP
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ORW: yes❑/P PNA yes / no Closest Maj. Wtr. Body /� l
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Agent or Applic t Pfr• ted Name Permlffi,Ier;s` Pr•nted Nhe
Signature P ease read/compliance statement on back of permit" Signature
OM �r/V
App ication Fee(s) Check# ;• Issuing Date xpiration Date

14 - ..
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 6-0AJ00 A 4V 's
(Nam of Property Owner)
property located at 6 g 2 0/c+ IPA m 1%w �l3 ��C-h �Cv.R'J' W Q s'�
(Address, Lot, Block, Road, etc.)
on PAAJ J;Lo cR— , in aal hAyed 4 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc I .
_I I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/Ok DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach site_drawing)
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.)
-Z 7 '�7'I~ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner I
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Print or Type
fling Address
2/hgvQ�v� /UC! P ? 8/0
City/State/Zip
Telephone Number/email address
Date
(Adjacent Property Owner Information)
A.
Sature
Print or Typ6 Name
�-�Lo IL00 0 Koo,
IV ilia Addressg o
i5 �QYZI3. Uc,
City/State/VZf
-
Telephone umber/Rma address
u� C�
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT /
I hereby certify that I own property adjacent to fZc�o A.)IZ4Is Su vl ekIt'`✓ 's
AA g}w�ampg Property
si`� Owner)
�t}rvt
property located at ��% ®!�X ft`c�
(� (Address, Lot, ock, Road, a c.)
on r V Lo �i UeA, , in v�sJ l ( 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
(Individual proposing development must fill in description
below or attach asite drawi_ng);
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.)
4- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
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Print or Type Namb
6 917 0lej PkIft I Q0 9_P4 c�D• LIA-It--
M 'lin ddress
City/State/Zip
1-- a�f��--
Telephon Numper/email address
0.2 /R,7/ 2dl 9
Date
(Adjacent Prop" Owner Information)
l LJ i
S' Mtr*
Print or Type ame
M X g Address
� %more -land h H- 0,5 4, 7
ity/State/Zi
R3,. J�T-v` 6, 6 �j&), DWgo),-&.Corn
Telephone N
�umber/email address
/ (
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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NC Division of Coastal Mgt. Habib Impact Computes Sheet
Date: s—%%%(4., or)o /
General Permit* ?pZ�j
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
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 ❑