67929D - Brown

ICAMA 1>1 ' DREDGE & FILL `7929 A B
MINIERAL PERMIT 0 1 Previous permit #
rNew E Modification ElComplete Reissue E Partial eissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 14, P� 60 ( 0-1 %oo
XRUles attached.
t Name Project Location: County 9V'VASV'(\'(
t o 0 VN^t- Street Address/ State Road/ Lot #(s)
AN ("I VIZ \LJJo' tateVA- zip -2 210 'i L - -2,
(qA -76 0 - -�-7 E-Mail Subdivision
Bd Agent
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[I EW 0 PTA El ES D PTS
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PNA yes/ 19
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AMA /DREDGE & FILL
GENERAL PERMIT
9g A B C
Previous permit #
.-Modification '.Modification Complete Reissue Partial Reissue Date previous permit issued
ut onzed by the State of North Carolina, Department of Environment and Natural Resources —�
the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC C 7 •25 bC ( C7 - .1 ® }
'icant Name _..._.— �+ �- -trU
_ �
ales attached.
Project Location: Coun ''Vtt+.
County
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Street Address/ State Roadf Lot # s
State ZlP 7 t D
W 'Z'' 1 b
re # NA0 37 to
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._--� _ E-Mail
Subdivision
orized Agent
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city ZIP
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NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: eauV v-\ Permit #. V7 9 Z 1 r
Date: `l / ! --1 /2
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 .
Feet
(Appliad..for.
(Antidpated final
(Applied for..
(FIN
(Anticipatedfinal
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
andlor temp
restorationor
temp impact
/
1, Dredge ❑
Fill ❑
Both ❑
QlrlJ� IIIIfJGK QIIIVYIII cnN uiiNactS./ d11IC1UIlCJ
Other sco , Soo
Dredge ❑
Fill ❑
Both ❑
Other 0
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dr edge
Fill ❑
Both ❑
Other
Dredge ❑
Fill ❑
Both ❑
Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to Stu C_ i L 2— j�: ! O W A 's
(Name of Property Owner)
property located at�
'+ (Address, Lot, Block', Road, etc.i
on f %uril i C_ ecc Vn , in 00-cu iI �<Jr 6 tt e e-24 N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
l 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)
DESCRIPTION OF PROJECT REQUEST
Official request for permits allowing emergency sand push witin bulldoze
according t0 CAMA restrictions, to push reach sand to replace destroyed sand
dunes and protect exposed sand bags done by Hurricane Matthew on thesouth
elevation of the structure.
WAIVER SECTION
1 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.)
l do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner
Print or Type Name G Ib CG, �I 4TL1
Mailing Address t ,
0 (Any th 4C'Sdr f f n U l� 2 iC77J
City/Statelzip
Telephone u er/email address
DQtP 4 1 1( _
fA jd"j�a en Properly Ovv er lnffoormatior!)
Signatu:rre* f
_ A:��.ey Sc kl UC14
Print or _
T, 7 C
_8�f3 �y`� - ©���Fir-f�•�.ys<•��^�N��L.�,�
Telephone N mb/email eddress
/J2 7/,
natr

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to .5te'r-i L i O �n/ ✓1 �'s
_ (Name of Property Owner)
)roperty located at �.�� e r C.P+ L�f-C�10 c.
(Address, Lot, BiocV, Road, etc.) —r--
m f 14),11 t L 0 e- c n V1 in _ QC- �cA ,i C f3 C N.C.
(Waterbody) (CitylTown andlor County)
the applicant has described to me, as shown below, the development proposed at the above
ocation
_ _V_ 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)
DESCRIPTION OF PROJECT REQUEST
fficial request for permits allowing emergency sand push with bulldozer,
-cording to CAMA restrictions, to push beach sand to replace destroyed sand
Ines and protect exposed sand bags done by Hurricane Matthew on the South
evation of the structure.
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
nust be set back a minimum distance of 15' from my area of riparian access unless waived by
ne. (if you wish to waive the setback, you must initial the appropriate blank below.)
u I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner
01-�--_.
ubrcuaw c ��yy /
Vnt or Type Name
lG (21► . " L —
flailing Adrdress �,it f-- - -7
(A jacepntt Property Ov�ner Information)
i
Signature*
_per
Print or Type(Name
_I b q RW2.a �A� \1S \A�0-.