73677_Jery & Paula Thornton_20190724

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
No. 73677
if
B C D
Previous permit #
Date previous permit issued_
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 15A NCAC 7 i a GC
[2 Rules attached.
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Applicant Name r f �ti 8 k'�ka Thof ( OY\ Project Location: County 1
) : ; F (, c16r�
Address ' ) �) I� j k'�CKJ �6r . Street Address/ State Road/ Lot #(s)
City I— _LC, Oj1- 0,���i State PC ZIP a—1 �C)'i
Phone # (rrE-Mail
Authorized Agent
Affected ❑ CW ❑ EW [31 PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Subdivision G C'u,-e-
City Lai be-4' C', + ZIP '?-)S 0
Phone # ( ) River Basinyc� 5 v c, Ian k
Adj. Wtr. Body V11 f �-X &,C, i I E 3(�,,,_cd (nat,jman /unkn)
Closest Maj. Wtr. Body 0110E rv<a Ti " 1-1)
Type of Project/ Activity k CA
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MINE
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Agent or p ficant Printed Name
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S' nature / ** Please read eorhpliance statement on back of permit ]*�/
Application Fee(s) Check #
Permit Off er's Pf-inted Name
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Signature
71 Ll /l e' 1211 /r L)
Issuing Date Expiration Date

NC Division of Coastal Mgt.-THabitat Impact Computer Sheet
Applicant: e-YYl � � 1 r n Permit #: % 3 �e 7 '7 /1
Date: r] / a `i /1 1
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/or temp
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
G w�i
Dredge ❑ Fill ❑ Both ❑ Other %
—impact
�! rb St�f
q LS
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 ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaImanagement.net revised:02/03/10

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify Thal l own propel ardjnt tQi�t,WlGf 1%1+Pii1 's
propefty to th atl `�.7'p1°`i�W 1>r, (Namo of PrMarty ?)
(Addme, Lot, S =R,pn in_ , N:C:
(we- terbody) (OHylTw nn anWorir ty)
The applicant has aesodbed to me, as shown below, the development proposed at the above
Ie0atlon.
I hove no obje tlon to this prop l:
have ®bins to this propoaal:
DESCRIPTION AND/OR DRAWINO DE RROPOiED D!VlLt?RM�NT
(Individual dosing dov0opmont musf Rif in dffcdtp #*- n SON► or aillaeh a slfe drawing)
.4
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwat-r, boathouse, lift, or groin
must be set hack a minimum distance of 15' from my area of riparian access unless waived by
me, (if you wish to waive the swstK, You must initial tho appropriate blank below.)
I do wish to waives ft IS' setback requirement,
I do not wish to waive the W setback requirement:
i
H x 119
(LI 0" IN OM W Irdbnnatwn) ( t Property Owner Information)
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AA
alid for one calendar year after signature*
or
c�
T Nam@!!!
pope
(Revised Ao9, 414)

l hereby certify that I own property adjacent to i r S s
of P Owner)
Property located at 2 f !le
�,' (Addre", Lot, Block, Road, etc.)
on.. .. LL y'j�,i .0 .� ,, in 11� 6G` Al N.C.
l (Waterbody) (City/Town andfor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWIING OF PROPOSED DEVELOPMENT
(Ihd*WuW proposft devek"nent must W In deucrip>ttvn below or attach a site drawing)
d1
c h, J ., c._
U�) 1 i
' J11;
I
WASECTION
I understand that a pier, dock, moorjng PMFqM boat , ,
must be set beck a minimum distance of 1S irom , lift, or groin
me. {(f you wish to waive the my area Of riparian 8ccess un waived by
�. YOU n mt initial the appropriate blank below.)
i do wish to waive the IS- 8811back MqWrement
__________ I do not wish to waive the 15' setback requirement"
Ir""JP0r=y VWner Information)
M
D,te•
`Valid for one qrendar Year after signature' (Revised Aug. 2014)

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