66398D - Allen

-�Cl�MA / ❑ DREDGE & FILL 01V
hA
GENERAL PERMIT 226
B
Previous permit#
RNew ❑Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
nt Name Yoy ;GJ�/'�+.f( Project Location:
❑ RuI j�ttached.
County Y ~� G
> Street Address/ State Road/ Lot #(s)
.4-,aoeW StateLVC�IP 2k /4-:�?
i; l ,
'tq412) 21 -27.2g E-Mail Subdivision
zed agent (-. tit /1 6C1P w 4--t-f City v- n"t
r ZIP 2d-11
❑CW pIEW ' }PTA DES ❑ Phone # (
"— River Basin u� ~
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
Adj. Wtr. Body
A
El PWS:
yes PNA yes /;no� Closest Maj. Wtr.
Body
of Project/ Activity
�r,4'a'4kd U (Scale: ��-
ock) length k 7
'
latform s
Platform(s)
er(s)
en h
umb�r
ad/ Rip length_
✓g distan4 offshore
iax distanch offshore
=hannel .
ubic yards
imp
!use/ Boatlift
Bulldozing
N:�N:
% D, L"Wiml
❑ See note on back regarding River Basin
a Local Planning jurisdiction)

•
NC Division of Coastal .Mgt. Habitat Impact computer Sheet
Applicant:
Date:
Describe below the HABITAT disturbances for the application.
Habitat code sheet
,411 values should match the name, and units of measurement found in your
F1N�.L Sq. Feet
FINS
TOTAL Sq. Ft.
(Applied for.
(Anticipated final
Dplied istubance
Anti
distu
Disturbance.total
any
disturbance.
Excludes any
to includes
any anticipated
Excl
rest(
LDISTURBTYPEincludes
Habitat Nameose One anticipated
restoration
and/or temp
restoration or
teml
restoration or
tem im acts
im act amount
tem ifn acts
amo
Ck)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑ 1Both
❑_
Other n
Dredge ❑ Fill ❑ Both Cl Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill In
Both ❑
Other []

ADJACENT RIPARINN PROPERTY OWNER. STATEMENT
(FOIL A PIERIMOORING PILLNGSIBOATLIFTBOATHOUSE)
i hereby certify that I own property adjacent to 40--U- �� +'s
(Name of Property Owner)
property located at //25- A%-,!V,s
(Lot, Block, Road, etc.)
on 'CtAu in iy-C.
(Waterbody) (Town and/or County) {{
Applicant's phone #: ��� Z��-z Mailing Address: PZ5
Amplvopc z 3
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boadift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
Mow.)
I do not wish to waive
I do w;sh to waive that setback requirement.
----- ----------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRANVING OF PROPOSED DEVELOPMENT-
(To be fitted in by individual proposing development)
DOW
A
--------------------------------------------------------
(Information for Propem Owner Applying
for Permit)
i ui5 ;�w
Mai)* g Address
(Riparian Property Vner Information)
Signature

ADJACENT R.IPARRLLN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORdN G PILINGSBOATLIFTBOATHjO�/USE)
�WK-I hereby certify that I own property adjacent to d� 's
(Name of Property Owner)
property located at //Z.5— �fS .gyp-+ , Q
(Lot, Block, Road, etc.)
on r�L�,,i , in
�� , N.C.
(Waterbody) (Town and/or County) `
Applicant's phone Mailing Address: IJZ5 �44/40IA1G'
7
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
Mow.)
�Ild wish to waive
sh to waive that setback requirement.
--------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPNM
(To be filled in by individual proposing development) Off,
F-F-
P
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
5 s
Mai!' g Address
ri r/Ct�to /7in print nr Tvna l�:�mi.

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