66693D - Fisher

ICAMA / L DREDGE & FILL
31ENERAL PERMIT l l�' Previous permit# A B
New ❑Modification []Complete Reissue []Partial Reissue Date previous permit issued
rized 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
❑ Rules attaChd.
it Names Project Location: County nz)n�y'-AT
Street Address/ State Road/ Lot (s)
uti'C state
ft ❑ - al E- ail }} Subdivision
:ed Agent Jt, City C U ZIP
❑ CW XEW PTA ❑ ES ❑ PTS Phone # (`' ny ) River Basin
❑ OEA �❑ HHF ❑ IH ❑ UBA ❑ WA 4
Adj. Wtr. Body nat
❑ PWS:
Body -
yes / 1�o PNA yes / no Closest Maj. Wtr. Body
ium: n/a yes 9(4
yes
4ttached: y � no
ng permit may be required by:
Local Planning Jurisdiction)
❑ See note on back regarding River Basin r

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date: 07/� -7/2.b�' /.
Permit #: ( �� q3-1
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
found in your Habitat code sheet.
Habitat 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 fina
disturbance.
Excludes any
restoration andh
temp impact
amount
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 ❑
r ❑
Dredge ❑ Fill ❑ Both ❑tOther
Dredge ❑ Fill ❑ Both ❑ ❑

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2%07/2004 19:20 9108429806
GREG HOLDEN PAGE 01
Name of Individual Applying For Permit: �YL� t -�"%
Address -Of Property:
C)
(Lot -or strut treet or Road, City & County)
I hereby certify that I 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,
should be provided with this latter.
_ I have no objections to this proposal.
I understand that a pier, dock, mooring pilings, breakwater, boat
house, list _ must be out back a minim= distance of 15•
from my area of riparian access unless waived by me. (If you wish
to waive the setback, you =at initial the appropriate blank
below.)
I. do wish to waive the 15 t setback requirement _
I do not wish to waive the 15'setbeck requirement.
StUTS Date- I��

iiv/2004 19:20 9109429806
GREG HOLDEN PAGE 01
Name of Individual Applying For Permit:
Address' -of Property: _
'or Street F,
G• � .b . Iti L 2 �� � 1
or Road, City & County)
I hereby certify that I 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 developmient
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
_ I have no objections to this proposal.
I understand that a pier, dock, mooring pilings, breakwater, boat
house, list _ must be sat back a minim = distance of 15•
from my area of riparian access unless waived by me. (If you wish
to waive the setback, you no& initial the appropriate blank
below.)
k `' I. do wish to waive the 15tsatback rrequirement_ie.
Cl-
I do not Wish to waive the 15'setbeck requirement.
�Sigrt a Date • .

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K� . A