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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: &L, -M b"A." -C Permit #: (a -71(o-7--
Date: I L/ t y/Z o C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
found in your Habitat code sheet.
Habitat Name
TOTAL Sq. Ft
(Applied. for.
DISTURB TYPE Disturbance total
Choose One 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
I temp impacts)
FINAL Feet
(Anticipated fi
disturbance.
Excludes any
restoration an,
temp impact
amount
Dredge ❑ Fill Both ❑ Other ❑
lr�
Ul
Dredge ❑ Fill Both ❑ Other ❑
Z p0 d
2 6o b
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 ❑ Pill ❑ 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 ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Name of of Property Owner)
property located at 4 t S Jr N %/ R u-, VA
(Address, Lot, Block, Road, etc.)
on 4,
(Waterbody) 1111i(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
k,-- I have no objection to this proposal.
I have objections to this proposal.
..� ... DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
INTRACOASTAL WW Existing rock
area where rock is placed Sl n 1 line
Property of Property of Property of ' Property of I Property of
Forrest Cranfill 1i DeVane Charles Boyd DeVane Ben DeVane
Family LLC DeVane
1
43 Lt 4 S 5
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp. breakwater, boathouse, lift, or groin
must be set back a rninirnum distance of 1 a' 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)
[" fn r..r t r
t'rzrt or Type Name Print nr Type Name
fa t ng �t ldr� kfaiJiml Address
r— t . r� ,� c ), NC Z331 'L � c lei c 2 ?L - -7

AQJACIFNT RIPAR AN PROMERTY QMER STAILMNT
PrOp" J0C*PA1 at
on TL (Address, Lot
in
(Waterbody)
t of Property Owner)
;a-i.,Hate ,
(Cityrtawn and/of County)
The appficiant has desrstbeO to me as sho*,i be-iow. 0V A MW *Ve
iocation
I tuwe no obtection to ,Ns propos*
I have obo-dior's to this pfov<Sal
DESCRIPTION ANDiOR DRAWING OF PROPOSED DEVFt OPMFNT
(Individual proposir►q doveloPmerf must fill sn dP-;rriPtj-on below Or Oft4ch a $40 drawing!
e,4(J
v,;�c A k�t 06. Ceviaevc.—
I 4^�P% U A
L, WAWR SCT
I understand that a Pier -d pilings boat ramp tweairwater boato'souse lift re groin
must be set back a "miumum *stanc* of 15'ftom my area of npanan access unless warved by
me (0 you wish to waive the setback you MuSt in" t,," approonate bank betow
I do wish to were the it)' setback requirerwt-1
I do got wish to *a" t15' Setback mK""-wrtent
(Proporty Ow"W M*M"86") (Adjacent Property Owner frif ormation)
;Ij e
Pr#Tt CW "rYPO IV&'Y*
A**,&ss
A)
Toospoone iivu;&��;�id-�.i
tkl-f,v �/ I T.1-0 ...........
teMphow Nw*w / aftwi *d*4=
Age

INTRACOASTAL WW
Area where
rock is to be
placed
Sun
Property of Property of Property of Property of
Forrest Cranfill DeVane Family Charles Boyd DeVane
LLC DeVane
f1\ O1\ f Q O
Owner
statement
sent
Property of Property of
Ben DeVane DeVane Family
LLC
Owner
statement
sent