67935D - Crittenden

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3ENERAL PERMIT Previous permit #
*ew Modification ._]Complete Reissue El Partial Reissue Date previous permit issued_
rized by the State of North Carolina, Department of Environment and Natural Resources T�• C —1 0 f Oh
.-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Cg'� J O 6 V
t Name kvi ( , �i �
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(CO0) — 1171 E-Mail M ,
:ed Agent
❑ CW ❑ EW ❑ PTA <ES )(PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
no PNA /fes)/ no
f Project/ Activity
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❑ R' es attached.
Project Location: County Ne j,� "k1fN
Street Address/ State Road/ Lot #(s)
Subdivision
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ing permit may be required by: Ai' ►(. `�, ❑ See note on back regarding River Basin

NC Division Of Coastal M9te Habitat Impact Computer Sheet
Applicant: �-U.��.�.-, Permit #: ( -7 T C�--
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(413iied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp .
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts.)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/oi
temp impact
amount)
lV
Dredge ❑ Fill Both ❑ Other ❑
Z 300
Z Sob
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑: Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge.❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both Other ❑
Dredge ❑ Fill 1711 Both 171 Other ❑

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _I �,; �; s Cr; HiIQ r� r-
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
G
t\D. C . �2 Eel
2/D-- (Vl -f/,4,q -
1 �.
,-rn � /L��.
a�_1__l
pent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at O O a 10/ L O'
in County.
l furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
00 w A P--(
Title

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FOPM,
Name of Property Owner.
11-et- O-t'.J
Address of Property
(Lot or Street #, Street or Road, City & County)
Agent's Name #_ (% t`J :-)(—f L.
Mailing Address: _
6,31q
JJ r- ;
t �f %� ": Al
Agent's phone# 9/Q - .-Z3 /- YS/q
c i3 to-C
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t hereby certify that 1 own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter_
I have no objections to this proposal- I have objections to this proposal.
ff you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice.. Co►rrs4,ondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 284053845- DCW representatives can also be contacted at [phone] No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, litt, or groin must be set
acts a minimum distance of 15' from my area of riparian access unless waived by me. Of you
Swis to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.p� s o
( (f�PGIIy JO ( Ne�toCQ
I do not wish to waive the 15' setback requirement
(Property Owner Information)
Si tore
r,KM�:J
Print or Type Af me
e.
Mailing Address ��yy
(Adjacent Property Owner Information)
signature
OA*Aft k S„At—Itt
Print or Type Naive
c16 SO U( 18,% 51a lyl
Mailing Address
WkLML&t - 13 NC 7�34 a 1—

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to s
(Name of Property Owner)
property located at
Id L- �:/' / -<.
(Address, Lot, block, Road, etc.)
on l C in (, l.--i/'�_ 117,--' / .
(Waterbody) (City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above location.
J�\ 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)
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.)
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)
Sign Signature
Print or Type Na a ��— Print or Type Name

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