74163_Leslie & Tom Martin_20191106

AMA/ ❑DREDGE & FILL �pJ to 1 No. 74163
GENERAL PERMIT p* I,,�r.p Previousc D
Z W`f'O �, permit#
> Z ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 4/4
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 5A NCAC 07 I I 1 I Z O 0
/ ❑Rules attached.
Applicant Name /L ES l i7i ( d 7-0A4 Al 4 r T)/%/ Project Location: County /\4 L, rC O
Address 2 Pt .0 koLid C I?F 1 K fZ (7 Street Address/State Road/Lot#(s)
City /1E& ITr State Pk- ZIP olS-5 `.76
Phone#(MM0) t PS-it I ? E-Mail Subdivision IA)I-I01z 7)p
Authorized Agent /1 Z ZIP 28 (
��y[C� City �) 1 I� -
Affected ❑CW /"�W XPTA ❑ES ❑PTS Phone# ( ) River Basin N 1 US r
s : ❑OOM ❑HHF ❑IH ❑UBA ❑N/A
AEC(s):
❑ PwS: Adj.Wtr. Body FROW/J C(fir K" a, an /unkn)
ORW: yes / rio) PNAT. no Closest Maj.Wtr. Body \iCU% /21 0-
Type of Project/Activity /1UNUI't'TJ Z CO S'X 3o' r lA 4. K' -1 ! '
LIFT—
LIFr l
Pier(dock)length (Scale: ' - e ) ;
I
Fixed Platform(s) i S )(3� I i et _____ j
Floating Platform(s) I , oc,/- „stet cit'cy l lIjf D/- 2 >Ol
Finger pier(s) /, {� i1J1 L L
Groin length I h�f } ° S x> S
number V S 1 kt I / / r J go/
W
Bulkhead/Riprap length r— 1 n
avg distance offshore ��1 �� I
I • 4
max distance offshore "' `�0
Basin,channel ! I �' I r 1 5 n
ff [uVc rZC
I1 i ► ! • IA
cubic yards , I 41 r r
Boat ramp
1
1
Boathous Boatlift I3'it f 3 . • h
� IV
Beach Bulldozing 1—
� xmV ►jC n 1 / 911f►
Other �,�0
--I- - IL(F A-4c-/�'x13n vc -
Shoreline Length+/O0 ,
SAV: yes no + T.-._.- I .. .-.-..._ t r= j..-......_. ❑
Moratorium: n/a yes , , I 1�
I
Photos: yes 41112M_
I ► j
Waiver Attached: yes 40 (�h
AAA building permit may be required by: r M/. I C 0 COCv w�?)/ . I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
2
Notes/Special Conditions ->r( Q 714-I L a06, A,,me(Z 1 e C n 1--0 TA(... G r 'I LI D F 1 0 T ALL 01.4- 07
9o0rT z )fa/ ,tio .s I,J6clE STrz(A cr>^r?k 6IZrA-r)X 174Ar) 'too K i '.-
I
!-__: 5( ( -e. a1(�lrfii'1 kirV/J J1AJZ1-
Agent or Applicant Printed Name Permit Officer's Printe Name
i ' ! tik.k- ViV\(AVIA'. - 2
Signature **Please read compliance statement on back of permit** Signature
4Zoo. be, f IZLi G Nov Zola G it 4A)Zc vl Z©ZO
Application Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Q �✓� n ^ (jdam of Property Owner)
property located at 2(v9,4_ ev.5-2 V` rZ� K- 0�
,(Address, Lot, Block, o d etc.)
on BMW)/ s , in rn2((Z Nc- Taint iro Cf(A, N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I°
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 a site drawing)
Jc ?r,1 cy/ Lb .-66 .006 s 0 1 7/1c X㣥5 i .e6- b6c
i/-1 c o t tv POCK Pao.mod ie_r Y /Qir.) s
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 Info ati ) (Adjacent Property Owner Information)
6,4,14j- 11/104,1-2;1"-
Signature S gna *
14-i 5l re (4a . .
Print or Type Name Print or Type g3 t �T i 6 ►DR 2��.(eEtlime
YD eiLeek
►C�t
Mailing Address Mailing Adc(re
C Z;►LL , NIA 70/5-2._ emi NC_ 23SS6
City/State/Zip ity/State/Zi
703 - 3o y- 9-&�13 11-70) ro�5 Z�17
Telephone Nym r/email address Le phone umber/email address
Date gnu;C. c� Da f�511 e, alcerti r\� je/ekh o a
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMEN,T/fin
I hereby certify that I own property adjacent to Le-Sit e '— torn Mum L&" / 's
Marge of Property Owner)
property located at 2g 1(Q B(IslAJ 1 .,
i. (> Ka
(Address, Lot, Block, Road etc.)
on itrs n5 /t.�e - , in mirri ff-As- Pa svdd co c , .C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informatio /�1 (Adjacent Property Owner Information)
' , , , / )(( / Cr
SiLtel-6:e_VVILud-1;
:.0• re Sign tore* C
/ re ' / %t Al:Ae// 6 ' ,/-, l v(t�Vnar-fth
çr,jiyeme , � Print or T e Na e
boo IfiAl"-i Li
lc
Ma/p Addres Jfti (
,s ems„ Mailin ddresq
C !Stale ' . �., City! ate ip
_75
Telephone umbe email address Telepho a Number/email address
Cc Af 1 > CI Z,.0 l 11
Date Dater , rritr-&0 316 ‘i(a , .
(Revised Aug. 2014)

Applicant: LE-S c t C t-ID M. ri ARfi
r✓
Date: G No✓ Za i i
General Permit#: 7 N/`3 3
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.
~a `2` `" 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)
P W Amrt Dredge El Fill❑ Both El Other 3!er 1 3 to r j
Dredge❑ Fill❑ Both El Other El
Dredge El Fill El Both ❑ Other ❑
Dredge El Fill El Both ❑ Other ❑
Dredge❑ Fill❑ Both El Other ❑
Dredge El Fill El Both El Other El
Dredge El Fill El Both 0 Other El
Dredge El Fill El Both 0 Other ❑
Dredge El Fill El Both ❑ Other El
Dredge El Fill 0 Both El Other El
Dredge El Fill❑ Both ❑ Other El
Dredge❑ Fill❑ Both El Other ❑
Dredge❑ Fill El Both El Other El
Dredge El Fill❑ Both ❑ Other ❑
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