75311_Jimmy Warren_20191202

0 'CAMA / DREDGE & FILL —r D I' l04 qo(40 No. 75311
GENERAL PERMIT A C) C D
Previous permit# ;.//A .
'New _Modification ❑Complete Reissue _ Partial Reissue 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 5A NCAC 0 //7 , t/0dJ
❑Rules attached.
: Applicant Name Jr rim",m", lJ fit. Project Location: County �}CA ; .-
Address .�(.)6 ,,c I.tc P- f( Street Address/State Road/Lot#(s) 3 G(.. f-2,,,e 7/tc
City //< // State V( ZIP 7I& �2 Z
Phone#(_ '2) I - /61-- E-Mail Subdivision t.
/.l
Authorized Agent C I.Y. / /)<t., , City iL z f4 ZIP Of
❑CW L JEW E PTA P-ES ❑PTS Phone#
Affected ( ) River Basin / / ,.,
5 : ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC ,Adj.Wtr. Body Pe-,- le, Ai',
r r at man /unkn)
❑PWS:
Closest Maj.Wtr. Body P r+~i /r = .e•r
ORW: yes /� PNA yes / no
Type of Project/Activity ` , ./ /J ,'/., 6,„/ ere, ,-/e
'/ /6/f j. /p, /<., (Scale: / ' -..,--O' )
Pier(dock)length
r, Fixed Platforms) ` \d —
--.Floating Platform(s) p
— —
Finger pier(s) w 1. ((I _ I r t��
Groin length I I r rf F r _
number ,'
/�
iI
i
Bulkhead/Riprap length 17� 4)-. - -
ll[R*s
avg distance offshore L .11
max distance offshore ) i •
Basin,channel le?+
t ,
cubic yards iii
_.
Boat ramp I IMill
Boathouse/Boatlift ry
Beach Bulldozing Elig
Other 4NIIIIIIII
/1/ I -mac
I ' - T---, &IC? i - '
Shoreline Length /7 `/ „,;7...,,,, ., EN
SAY: not sure yes noME Moratorium: n/a yes 99.
! �
Photos: es
Waiver Attached: yes to__,. 1111111.—IPAIIII
A buildingpermit maybe required by: /. =--: r 9Iltee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions /MO
} PermitOfficer's1 /
' l \ ; N- --{�� i 5 r / I?/''f
Agent or Applicant Printed Name ll �� Printed Name/�
er
f`,4,I.-.f , - ••',- ::f. _7/ .�
Signature * Please read compliance statement on back of permit Signature
X--;(:>'7C-')
I 7 7 i A.22/,. .c/
Application Fee(s) Check# Issuin Date
Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date I g"
Name of Property Owner Applying for Permit:
/\A-AkV \\--)-Q1k- r 12- k
Mailing Address:
P�
_
I certify that I have authorized (agent) C_-\ 1511 Q l5 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) 1-t 1 � ��� Acee, i
at (my property located at) '30 t rA eQ
This certification is valid thru (date) 3
Property Owner Signature Date

' ADJACENT RIPARIAN 'ROPERTY OWNER STATEMENT
I hereby certify that I own property adjacer :to
property located at__aaia_R ��,eeN�►�e f Property Owner)
on `v� (Add ess, Lot, tcAad, etc.)
in
(Waterbody) (City/Towr and/or County) N•C.
The applicant has described to me, as sr )wn below, the development proposed at the above
location.
I have no objection to this jp Dposal.
I have objections to this prof osal.
DESCRIPTION AND/OR DRA KING OF PROPOSED DEVELOPMENT
(Individual proposing development mus `fill in description belorr or attach a site drawing)
I understand that apier, dock, WAD ER SECTION
mooring pilii gs, breakwater, boathou;;e, lift, or groin must be set
back a minimum distance of 15' from my E -ea of riparian access unless waived by me. (If you
wish to waive the setback, you must initial :he appropriate blank below.)
l/—1 do wish to waive the 15' setb ick requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Prope ty Owner Information)
•)1 \crk �1octen , �� £
Sig Lure I
\cx\M� � Sig ure c
P ' t r T, eaie\Qcr ec • �)QkLI
`S6.9 1Natv c..ca 1' Pjl Typti erL
M".. g res M in�A�dpr �l ') lDrive.
City t tp •`- si W �l J Il y 7�9
Tee e 3 j ^ j 33 City/S ate i _ 1
Num er rhoeI7i9
mbe ��
Date
Date
(Revised 6/18/2012)

" ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own ro e
p p rty adjacent to 1 mVI k.).\(\s-r f� .s
a Owner)
���L� (Nar�ie of Prop
property located at 1J 2ifle. f ram.:
on ,i CiD1v tr (Address, LotmRoad, etc.)
• in , N.C.
(Vllaterbody) (CitylTown andlor County)
The applicant has described to me, as shown below, the development proposed at the above
locatio�
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
•
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
MJ �r I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Digitally signed by Millard Juba
3strotiV.\arrenXM i l l a rd Juba Dtl.cn-N4llard Juba,o=DynGorpinternational,
ou=NEFRSC,emalklllazdJubagdyMntl.com,
�—
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of T�0$ M •
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cltgzss31 I $ss C 1 -r�1 � _ r$94
TeleptNne tuber Telep Nu
IPA 13014 �019
Date
Date
(Revised 6/18/2012)

NC Division of Coastal Mgt Habitat Impact Computer Sheet
Applicant �J< w N W /v
Date: /o? //
General Permit#: 753// /J
Describe below the HABITAT disturbances for the application. All values should match he 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
Habitat Name DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or tern p restoration or temp impact
JJ / temp impacts) impact amount) temp impacts) amount)
$ /` Z',J�f�'bredge❑ Fill Both ❑ Other ❑ f 7
Xiterk- >c Dredge❑ Fill❑ Both ❑ Other Pr- / 7, /7_5—
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other 0
• Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other 0
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑