74178_Dan Weiss_20191114

I. e VCAMA/ ❑DREDGE & FILL ''``�QQ''�a No. 74178
�`�o A C D
GENERAL PERMIT 1� Previous permit# N/.!
)G ❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued Af
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 (7) 7if. 120 0 .
r ❑Rules attached.
Applicant Name Z✓l+n lien // Project Location: County /��z,,,/.. f e':-.0
Address /2 c/ t`/ .. L` t,ri j,/eve Street Address/State Road/Loot,#(s) it- %? ///
City 1?, /rt.-sl H/� State Lf� ZIP 1/555/ / 7 / !- hJ y?� ,(A- 4.27J-/
!. Phone#(f//C9) iffy"-/‘t/S E-Mail — ---- Subdivision /i (' er r/' /.,
Authorized Agent City %� //,-, . ., ZIP 2 7J1
Affected ®CW Ei'EW Tr-PTA RES El ----PTS Phone# ( -- River Basin 7 - -//,e,eon
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body 1...-(;,-.),_ at et e k man /unkn) •
❑ PWS: p
- Closest Maj.Wtr. Body (A" c ! 1`V('
ORW: yes //'no PNA yes /,fO
Type of Project/Activity A., /6,0 r i T C �.. 1 l/ i i ri t c i c/1 !6+CI�r/j'(ri/<i --/v� i l (/ o�><N
-26,'x,,_26' /,1 i/ram-,-, J / , .,>'./. ' 1:), / / // (Scale: / =--, 01 )
Pier(dock)length_' 11 0 ' Y r!
II I
Fixed Platform(s) C ,',.:1 G'
Floating Platform(s) le'l I—"---' '
Finger pier(s) I 4 v') rt C
Groin length
number -_- ]i
Bulkhead/Riprap length ____ f I
1
avg distance offshore --- - A
f
I - I
max distance offshore --- I I
Basin,channel b
1 h
J i I
cubic yards _ 1 IC, O- 1 i
Boat ramp F j
Boathouse/Boatlift 17 ,/7
( Beach Bulldozing -- c,,(
Other`'
. 41e/'(.14 .1..t_ :,
Shoreline Length Zr� I v'� f A
SAV: not sure yes i ' ' 1— ._...._.._ -- nrt C
4•
dam' �----- 1
j -, I �
Moratorium: n/a yes no 1
Photos: es no �_. —
Waiver Attached: yes 1 1 no '
A building permit may be required by: //c I�' l 7 Co• See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions nl‘,. i�lcf.-e f/�L. I/6 Ulf. ,f /2� /1,-,„ ��:, fi J i,,.� d ,��.
ge/ , f ,. -// ;ter .. �-1e. ,�1 �i ,.�, I; L. lire ..-}L G ii.,: ., ,YAL
LA-N M , WE/sS .� C r SE >4
Agent or Applicant Printed Name Permit Officer's Printed Name
i-)'I• q —
Signature Please read compliance statement on back of permit** 'Signature
,2 )& .71//6/ , 4, /9 .Iil / . /// ._,?v.
Application Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
4S
I hereby certify that I own property adjacent to bA1.1 4 `ennn 'S
(Name of Property Owner)
property located at 131 herl Way e IhaVtv'►/
(Addres&,'�ot, Block, Road, etc.)
on Au P CAz ct4. , in Bei hrwcri , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. As
" 'v i y�U/
I have no objection to this proposal. cs�/e) v +��
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)
R ecr ect+ona I Doc-V.
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 Information) (Adjacent Property Owner Information)
.44 f4 Vb-e '—
Signature ignature
S+e Ite f R c• harm Poo le) Jr.
Print or Type Name Print of Type Name
+50+7- ci ne R ct to
Mailing Address Mailing Address
P,r:! i11 C 0
City/State/Zip City/State/Zip
- `-q
Telephone Number/email address Telephone Number/email address
2rict
Date Date* ( l
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Dan rx ,Iecu e Wei5S 's
(Name of Property Owner)
property located at t 3 f "'.1'her Wt / ( el ruvve/11 t.C a'I-JR i o
(Address, Lot, Block, Road,etc.)
on
C'2EEK , in 6ei hcw-e.n , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loy.
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)
R.ecjea-I-►ona.I Dock
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 Information) (Adjacent P `. rty Ow Information)
I
Signature Signature ,
Ms. Li4a (ramci
Print or Type Name Print or Type Name
r3 -tt,441.i I IZvod
Mailing Address Mailing Address
Mvt1i-au.k 1 N Y l t q--f
City/State/Zip City/State/Zip .
631-668-' ,/ fP�'i L' optryi 1`oe,nei
Telephone Number/email address Telephone Numberemai address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

NC Division of Coastal Mgt. Habitat Impact Computer S1ieet
Applicant: taH VGr'SS
Date: // j�f //
General Permit#: 76// 7 O
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. (Anticipatedf9nal (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 tern p restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
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