67240D - Ebert

CAMA / ❑ DREDGE & FILL Ll
hIENERAL PERMIT �� I�7 A �` B
Previous permit #
fiew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Ciommission in -an area of environmental concern pursuant to I SA NCAC
11 les attached.
Name '" C� �� Project Location: County �14' Jit
S2o� 44aw kS�S, l._a�
1 State`k ZIP 2�
W Agent V a� nn CLV\
❑ CW kEW >dFTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
C PWS:
ees .) no_
PNA yes a:)
Project/ Activity
Street Address/ State Road/ Lot #(s) %
i Z 1 JO c.ilL Ayt •
Subdivision
City 1 1 ?jegc'i ZIP
Phone # River Basin
Adj. Wtr. Body NV 5 C- �f1i11Al�Lf'7(n n
Closest Maj. Wtr. Body�!�'
(Scale: l�
k) length {�
tform(s) .- t +-- { _ .... j f __ _ .. .Iw T-7.-.�___.._
Natform(s)
igth
nber
I/ Riprap length
distance offshore
c distance offshore
annel
is yards
p
y6oat "
dldozing
Length '` /01
not sure yes
(,Ano
um: n/a yes
yes
attached: yes
ig permit may be required by: ��< °�` 6Z ❑ See note on back regarding River Basin ru
_ocal Planning Jurisdiction)

NC ollvision a1F 1mols ,cdr.ox ;pr.. ®mom tl`�� Pa.PRYw -
Applicant:o'1
/2e
Date:
Describe below the HABITAT disturbances for the application.
All values should thatch the name, and units- of measurement found in. your Habitat code sheet.
TOTAL Sq: Ft, FINAL. Sq. Ft. TOTAL Feet FIN.
(Applied for. (Anticipated final (Applied for. (Ant
DISTURB TYPE Disturbance total disturbance. Disturbance d'tstt
includes any Excludes any total includes_ Excl
Habitat Name' Choose One anticipated restoration any anticipated rest
restoration or and/or temp restoration or teml
tempim acts a im ct amount —tempirtt acts amc
® („J Dredge ❑ Fill ❑ Both ❑ Other
Dredge [] Fill ❑ Both _ ❑ Other ❑
Dredge ❑ Fill Q : Both .❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other C1
Dredge ❑ Fill ❑. Both ❑ Other ❑
Dredge ❑. Fill [I: Both ❑ Other ---------------
❑
;';; Dredge ❑ Fill 171 Both ❑- Other 171

ALvV-wAA
WDEHR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Bevery Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date q-12-1�
Name of Property Owner Applying for Permit:
,i a/oA JoQm 6ef t
Mailing Address:
2
I certify that I have authorized (agent) CI Vo �C m to act on my
Ili
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) 1 1- 3 0- N

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to ,
property located at l aZ ,)- go r- y 1< ,�ve
AI,t r � le 4-� erf
(Name of Property Owner)
Block, Road, etc.)
I
on C.4,� ,in // N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: q10 A Mailing Address: %Z d�v�� Gf
IfI4 .2gWf
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
im arian access unless
waived by me. (If you wis to waive the setback, you must initial the approprilre
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Sec tizz^�<,�.0
----------------------------------------------------------
(Information for Property Owner Applying
for Permit)
(Riparian Property Owner Information)
Mailing Address Signature

r
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the maifpiece,
or on the front if space permits.
1. Article Addressed to:
In,ckRel Lee
lS L1 Kno1&uo,-.-e Xk
A. Signature
X ❑ Agent
j l Vitem17
ddressee
B. Receivedby(Printed N eof Delivery
D. Is delivery address different Yes
If YES, enterdelivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
I
III
III
I III
III
III
III
I
I
III
El Adult Signature
❑Registered MaiITM
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
,II
9590 9402 2145 6193 4306 73
1❑ Certified Mails
Certified Mail Restricted Delivery
Delivery
❑Return Receipt for
1 n
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
Merchandise
❑ Signature ConfllmationTM
- — -'
fail
❑ Signature Confirmation
7 015 1730 0002 1609 0118 fail Restricted Delivery
Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
■ Complete items 1, 2, and 3. A.
■ Print your name and address on the reverse X
so that we can return the card to you.
■ Attach this card to the back of the maifpiece,
or on the front if space permits.
1. Article Addressed to:
�l err Y C 0'n e-s
Is deliveryUdres$ different from item 1? U Ye:
If YES, enter delivery address below: ❑ No
3. ill Service pF7 PMail riority
®
n Adult Signature Registered MailRIIIIIIII II I III III II II IIIII II I P—m,raA n,ti, rr.A