75414_Forest H. Williams_20191121

.'CAMA/ =�DREDGE & FILL No. 75414 A B C D
GENERAL PER
MIT Previous permit# ^1 /A
��-= i'1 ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued N /4
As authorized by the State of North Carolina,Department of Environmental Quality D 7� 11 0 0
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC ®Rules attached.
/ -atiTv� r L� •
Applicant Name .rG'P goT ^/ ' )✓/LLJ'4'� 5 Project Location: County .Bc
Address 5 5 2 �o w 6 -72'1 • Street Address/State Road/Lot#(s) d tiF S R. I '1 1 0
City A N TL.41 State iLi G ZIP ,2 7 e0 L. e ,>', 2 e' .
Phone# (2S2) (o7D-//7(' E-Mail Subdivision --
Authorized Agent Ai /4 City A y7z.4, A ZIP -7 'O(4.
o 'TA ❑ES ❑PTS Phone# ( ) River Basin TAb24,�2 . 1 1 i-' (L7
Affected eWW / "
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body Alt-eat:,J G/2&--EX na /man /unkn)
❑ PWS: �n��,'� �ivyL
Closest Maj.Wtr. Body
ORW: yes / no1 PNA yes I na)
Ill Type of Project/Activity .',,J'a 7,-*-, . A,5 t ,P it r
le
(Scale: � `3 a )
Pier(dock)length
1
Fixed Platform(s)
� ■ �■■ 1� •
i
Floating Platform(s) ■ �— — ■■ ' +
Finger pier(s) IMINIEril�■■■L:�AmummummEmmommiz � r�( ,� �i lid ■'/-/.4 r
. '
Groin length ,N V� m ■■ r�a �■ + _w ww
number ■��■■ ���9'� - sIBulkhe Riprap length—,(o •I! UIIHIIi1I1 ••. r�, ■■■■■■— ` ,, �. •�
avgdistanceoffshore /0/ �orriv�■■ii
, a p�„ ■■max distance offshore /C f
Basin,channel 1IIkiiiiiiiuuiu
s I . ���
cubic yards & HhI
ri UiIHiiIUH
It
t
Boat ramp I i Si I.
Boathouse/Boatlik I ? ! iiUHI1IIHIHhIII- j
, i1 IIII_ __ is, ■■ !:: ■■■ ■
':
Beach Bulldozing I. � ■■I■ ■■ ® ■■■■■mill
1111W. 1I1L■1 ,r- '©©■■■■ IMAM ■■■■■■■
Shoreline Length --�5C/0 i1. , ,gt ' I ■es �o HIPV III ii _
Moratorium: n/a yes QD ��1 ' III H
mil" IHHHIIHHHHHI�■■��MIMEL54151ii■■■■
Photos: yes n• �■■■■■■■ ■■■■■■■■ .,
F, i ■■■■■■■■11 , i
li Waiver Attached: yes no
•6 r
A building permit may be required by: 1'S��—/-4-Yt%-z..t r-- le..) . . Ai See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions jZ,/1-7 42-A' 1'1-'i 7R. &�" c)-. /0 l-v4--j�72 u-A ✓0 0 f' �). w ' 4- •
5 0 t'L CZ J p ,e1-7,..n `,a7 ter- r-h.-a RECEIVED
DEC032019
y �- s- — �"J1'L Li
rG�,� c '1/Agent or Applicant Printed Name Permit Officer's Printed Name i DV M_WARO
��
ignature **Please read compliance statement on back of permit** Signaturf
,2d 4L. 1 .9G'' / -3 2/ 1-//v6. .g,,n 2J 'y ' r^. c,-f 2_v'20
Application Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to / ct , L C, s 's
(lame of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on M 0, i 2/;? C�� e k , in r e2 a u , N.C.
erbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iocatiop.
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)
RECEIVED
NOV 1 9 2019
DCM-WARO
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.)
). C j I do wish to waive the 15' setback requirement.
VI do not wish to waive the 15' setback requirement.
(Property Owner Information) (AdjacenePr erty Owner Information)
L sign9t / /
tgFtY r e•s 7 1 tit 1 L i a. 415 f'f'� .0/
Print or Type Name Print or Type Name
Mailing Address Maih g/.Ad ss ,(
A v-d�' /4/ 2-7564 / fl 1 L
City/State/Zip 6 City/St / ip ,
Telephone Number Tel pp one Number
Date Date
17 ( (Revised 6/18/2012)

1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4 5'A I- �/ 19(k v1L e S 's
(Na a of roperty Owner)
property located at 5 k±L `v e
� (Address, ot, Block, Road, etc.)
on h41,_c�id/ C , in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
RECEIVED
NOV 192019
DCM-WARO
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.)
/h 9 I do wish to waive the 15' setback requirement.
,e I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Z._
Si:na ire ,/ Signature
n t or Type Name, ! / Print or Type Name
!T2 L
' e<, kid (., l �� i,'c % /' `f 4%
Mailing Address Mailing Address �.
5 2 R - . )-* -/ 4r r -, ; tei
City State/Zip City/State/Zip
Lt.rL.zL AI r6. 27 Yz
elephone Number Telephone Number
-, 7(L) •i / 7L `s
Date Date -
1
(Revised 6/18/2012)

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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 1,J A,,...
Date:2 7 nl a v Z�t 9
General Permit#:
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. j TOTAL Feet I FINAL Feet
(Applied for. (Anticipatedfinal (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 temp restoration or 1 temp impact
temp impacts) impact amount) temp impacts) amount)
f I I
Dredge❑ Fill❑ Both ❑ Other ® 166 F7- / bs 7-_
Dredge❑ Fill❑ Both ❑ Other ❑ 1, .( D 11 /,co 141-
I
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑9
Dredge❑ Fill❑ Both ❑ Other ❑ I i
1 I
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
I �
Dredge❑ Fill❑ Both ❑ Other ❑
II
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
j
Dredge❑ Fill❑ Both ❑ Other ❑
• Dredge❑ Fill❑ Both ❑ Other ❑