66659D - Corbett

CAMA / ❑ DREDGE & FILL
PENERAL PERMIT
New [-]Modification El Complete Reissue
IZL 9/2a�d
❑ Partial Reissue
!zed by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
A B
Previous permit #
Date previous permit issued
l
. ❑
Rules attached.
is
Namet.��`j�
vY Q�� � � L, �yAi—
Project Location: County
r
r Street Address/ State Road/ Lot #(s)
State
% ZIP i � 11 �'i `c . � ; fi .1 � -1'
( f)r
APE -Mail1
Subdivision
.,d Agent
1, 1
d� Yl ity t,}! �s
IC
ZIP b� �
❑ Cw
' w 44A \E
ElPTS Phone # ( ) River Basin
ElOEA
ElHHF ElIH ❑ BA ❑ N/A Adj. Wtr. Body
t114
❑ PWS:
I
es no ,
PNA yes / no
Closest Maj. Wtr. Body
Project/ Activity
(Scale: (y=
k) length
tform(s)
'latform(s)
:r(s)
gth
fiber
I Riprap length
distance offshore
c distance offshore��
innel 1
is yards
e/ Boatlift
IX
Length lY U
not sure yes 6
im: n/a yes
yes
ttached: yes no
g permit maybe required by:h`' a t L' Oak r �,j/\�.1� ❑ See note on back regarding River 111asin ru
.ocal Planningjurisdictio

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: L "V V Ywu
Date:
Permit #:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Found in your Habitat code sheet.
iabitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied 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
I disturbance.
Excludes any
restoration and/or
temp impact
amount
HDredge
❑
Fill ❑ Both ❑ Other
�C
/
—'
Dredge ❑
`"\' ❑ 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 [I
Dredge []
Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑ Both ❑ Other ❑
Dredge 0
Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: CrV-eel
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
v
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: I/c'itJ A , " C//(-/koe/
at my property located at
in b h4rf kJt 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
o1wfv-'�(-
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to is
(Name of Property Owner)
property located at L3 L� 1.S�
(Lot, Block, Road, etc.)
on /)t4 (- J in « odt t6 /0�71 , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: k'QU; A39 Mailing Address: w jJ
Ad ej Anlir'nc,
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
P, N
d re?a��
�Urr*
01 ►v 10,7
�'� ,�r
fir �s
------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) )
d-&- S3 r-q-)� 7wo�
Mailing Address Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C�i is
(Name of Property Owner)
property located at Ld _i W tb � Lbn�
(Lot, Block, Road, etc.)
on aC�-J , in o.o -,t /a+'7f , N.C.
(Waterbody) (Town and/or County) I
Applicant's phone #: 2Q--s2.3t2522Mailing Address: a�� CJ
2 � YY3
AW
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
-ZarYr 1 ca-4
)a 1 1031'5����v
ss
-------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying
for Permit)
3321 �JG 14u 55
Mailing Address
(Riparian Property Owner Information)
Signature
to