73692A_Slater, Michael & Lynda_20190730

r.
ICAMA / DREDGE & FILL
9ENERAL PERMIT
New ^Modification ❑Complete Reissue El Partial Reissue
No. 73692 S 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 I SA NCAC
EX Rules attached.
Applicant Name M, c hat ` L4,e ✓ Project Location: County
Address 'i I j a- o vt / Ic 12 J
City V, « , G 11A c, ►. State_VF ZIP ,41 c, I_ j
Phone # (3-5-7) H 3 -a 69 5' E-Mail
Authorized Agent 6cet, h a,, t k t ,, J C,
Affected ElCw � Ew PTA ElES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /P PNA yes /(51
Street Address/ State Road/ Lot #(s) a ►c, �,
Lv t 4 ► �,c� i S
Subdivision C e c o uc, (3 h
City Coro 11a. ZIP
Phone # ( ) River Basin 'h K
Adj. Wtr. Body 0-,.,.1 �o kr,>tf � 1 %6-0 &(nat /unkn)
Closest Maj. Wtr. Body Cyr ; , , k S,, r4
Type of Project/ Activity Eyj,._�
MI
■■■■�i■■■■��■■■
■■■■■■■■
■ ■NOME■■■■MEMENNEEN
ON==
NONE ■m
. M ..
■
Age �rAppli rinted e
Signature `Please read iance statement on back of permit"
,�{a+�y.a� 1ft.il•<n•c(.W� 33[stoA' '�34o9�a�7
Application Fee(s) Z,�� p h Check #
Permit Officers R9ted ame
Signs e
f3�/1di� r OAL)bof 7
Issuing Date Expiration Date

NC Division of Coastal Mgt- Habitat Impact Computer Sheet
Applicant:
Date:
Permit* � 3toy fi
Describe beAf 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
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)amount)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
d W
Dredge ❑ Fill ❑ Both ❑ Other K
) Q �
ct
) 1
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 ❑
1 "I LA
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02103/10

rcwri,y
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to n( 6f. I S' d� is
(Name of Property Owner)
property located at c10 ! vZ � C!Z
(Lot, Block, Road, etc.)
on ��� f �� C� �0.��1� , in �Gf , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: %h 6 RACE eoeir C
6e&l It !1C , 9-61-71
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
--------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
1
1 6L tci-a !
4�? ' s he l 44- 'rz'+Xn
Pt :V `cA'�'-Ar- (lei �k
(Information for Property Owner Applying
for Permit)
Mailing Address
ek
City/to/Zip
Telephone Number
Signature Date
Ii0 •� `�% SGC� 1 •.cZ
(Riparian Property Owner Information)
11 Signature
�P (�/�_ d�f
'Print or Type Name
q57 3Y3 q-7vo
Telephone Number
;!Tv'iC z.z'z a� 9
Date
I,.xr---,q4 U ,,j DFRS-ram Dm.QG- -714A
Tom.
CA&SA L z S Z-Y
/fro J-c'_ l,J=DV--

■ Complete items 1, 2, and
■ Print your name and address on the.reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
404
Ch(? eat L) 2332-Z
9590 9402 4603 8278 9226 18
2. Article Number (Transfer from service label)
7015 3430 0000 2881 735
PS Form 3811, July 2015 PSN 7530-02-000-9053
❑ Agent
X �/ C ( ❑ Addressee
B. elv by rin Na C. D to of livery
fu
D. Is deliykry ad4ess different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
1
0 o
3. bavloe tyV,
_, ehority Mail Express®
❑ Adult Signattirn
❑ Registered MaiIT"
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certified Mall®
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
Signature Confirmation—
❑ Insured Mail
❑ Signature Confirmation
Nail Restricted Delivery
Restricted Delivery
)o)
Domestic Return Receipt

v
w
N '
r
r- Ns