66533D - Drach

1CAMA / ❑ DREDGE & FILL G I �p
GENERAL PERMIT ICU' (l ` Previous permit# A B
41ew ❑Modification ❑Complete Reissue El Partial Reissue 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 I SA NCAC
rVR les attached.
Name C Project Location: County /(/�2yr,G'l✓
�f! t�i +1� • Street Address/ State Road/ Lot #(s)
/� h State ZIP 2072 `�l' G° _; f• ��!/��i'�i f ��!
( AO) F66 -29'� E-Mail — —
ad Agent
( _. •1✓lr,� &,-144i� 4' , .
❑ CW
❑ EW ❑ PTA Ptl ❑ PTS
❑ OEA
❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
yes / no
PNA yes
Project/ Activity
:k) length
tform(s)
%tform(s)
igth
fiber
/ Riprap length_
distance offshore
c distance offshore
annel i
is yards_
P
e/ Boatlift
Ildozing
6 / fl,
Subdivision
City `1/Q �';)?
Phone # (i)
Adj. Wtr. Body
Closest Maj. Wtr. Body
Inn! ME■MEN�:�■■�■■■®MEN
. U /■=■■■i9rIN
ZIP
River Basin
(Scale:
❑ See note on back regarding River Basin
/ - C

Applicant: ���� �✓��"7
Date:
Ntvr Ohdslo" of Coastal Mgt, Habitat impact computer S1 Ot
Permit #: X S 33�/
Describe. below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
t
Habitat [Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tem Ainpacts)
FINS
(Anti
dis
E)�
re
an
imN
Dredge ❑
Fil(
Both ❑
Other ❑�
Dredge ❑
Fill F1
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 ❑
Dredge ❑
Dredge ❑
Dredge ❑
n
Fill ❑
Fill ❑
Fill ❑
Fill 171
Gnu M
Both ❑
Both ❑
Both ❑
Both ❑
R,,fh f" 1
Other ❑
Other ❑
Other ❑
Other ❑
Other ❑
�L. Sq. Ft.
TOTAL Feet
for.
FANAp Feefinal
abed
;ipated final
(Applied
,urbance.
lodes any
Disturbance
total includes
disturbance
disturb
Excludes any
g6ration
any anticipated
restoration and/or
_
Vortemp
restoration or
temp impact
damount) _
_ temp impacts
amount)

NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor
Secretary
AGENT AUTHORIZATION FORM
Date: �3'" 3ci - l (p
Name of Property Owner Applying for Permit:
DD
Owner's Mailing Address:
Ot coo 9) 5-f • �S/WI24�,s 4:1 .
iM,\A I, fvII , Iv c ZS �l z
Email: bANLCI, ; . [vvv,
Phone ONO
Name of Authorized Agent for this project:
Agent's Mailing Address:
Zl dl��-/�/ ?3 �� �'�✓rr f
/4Y r4.1"
Phone 6&)--26 — S-66 e
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and obtaining all CAMA Permits necessary to install or construct the following (activity):
MC
For my property located at
This certification is valid 1 year from (date)
3 - 3o-4 (o
Property Owner Signature
Date

DIVISION OF QQASTAL Ivy _AGEMEN?
ADJACENT RIPAR M PROPERTY OWNER NOTIMCAT10_N/WAJVU FORA.
Name of Individual Applying For Permit:
Address of Property: l e yl
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The
individual applying for this permit has described to are as shown on the attochod drawing
the development they arc proposing. A description or drawing, with dimensions, should
be provided with thi§ letter.
_ 1 have no objections to this proposal.
If yea have objectioaa to what is being proposed, please call Debbie Wilson with the
Division of Coastal Management,127 Cardinal Drive Extension, 'Wilmlagtoa, NC
2MO or call 910-79&7215 within 10 days of the receipt of this notice. No response is
considered the same as no objection if you have bees notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, moorings piliags, breakwaters, boat Louse or boat Lift
mast be to back a minimum distance of 15' from my area of riparian access- unless
waived by me. (If you wkb to waive the setback, you must initial the appropriate
blank halow.) , ,
I do wish to waive the 15' setback requincmew.
1 do not wish to waive the 15' setback rcquurmcnt.
ZSNarnen Date
Print

NAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
C(Name of Property Owner)
property located at J ce-
(Lot, Bock, Roa (,4, etc.)
onC�' �(/1� , in � ► t-u _ , N.C.
(Waterbody) (Town and County)
Applicant's phone tl: �66 %-73 2mailing Address: Oto U S 54.' S L.¢,,)
(�W 2-
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)
gf��� a qa-j� .
(Information for Property Owner Applying
for Permit)
�06 � S4. S v(",s C`'1 •
Mailing Address '
l _itvro Ate/741
(Riparian Property Owner Information)
Signature
Print or Type Name

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424 -86�-7632�
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2728 North 23rd Sheet
'Arnington, NC 28401
phone [phone]
lax 910.256.0175
duncanmarinemccar
DUNCAN
MARINE
CONTRACTORS INC
A giant among our piers.
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