66635D - Gasque

❑CAMA / ❑ DREDGE & FILL L V jj ,1 G l c0 A B
GENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
3rized by the State of North Carolina, Department of Environment and Natural Resources / L l , l
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ( 7 y .0 V
` ❑Rules attache .
nt NLI &4S 1� Project Location: County �_LhLw+��
Street Address/ State Road Lot #(s)
`---
tA-b V^ State ZIP 4 �5
( 0) �_l5 - 71 d E-Mail �__-------- Subdivision
zed Agent �(Y�� M.� 6` �Pi W VV VT City L� Cak vi rW zip
j ❑ CW �KEW PTA ❑ ES ❑ PTS Phone # River Basin �-I✓V'
❑ OEA ❑ HHF ❑ IH ElA ❑ N/A Adj. Wtr. Body CoL 0 t'i1,, at
❑ PWS:
yes / ►o� PNA yes no Closest Maj. Wtr. Body
of Project/ Activity
ock) length
'latform(s) I—
g Platform(s) x I t
pier(s)
ength
umber
ad/ RipIlenvg distaeiaxdistechanne
Bulldozing
ine Length
)rium: n/a yes Fo
yes
Attached: yes no
ling permit may be required by:
Local Planning jurisdiction)
i -1 A j
❑ See note on back regarding River Basin

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �C �d\i ba so--C Permit # :
Date: ! Y 3 S
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
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
cts
FINAL Feet
(Anticipated fin
disturbance.
Excludes any
restoration and,
temp impact
amount
f . /
W
Dredge ❑ Fill ❑ Both ❑ Other Pf
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [I 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 El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 11

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date � 44 1 L�
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) ,
• to act on my
behalf, for the purpose of applying for and obtaining ail LAMA permits necessary to
r
install or construct (activity) HAk) k,6 W -e
at (my Property located at)'
This certification is valid thru (date) ��

16 11:12a Kristin Dowdy State Farm
316 09:33a Carolina Bluewater Const
9107549566 p.2
910-575-1214 0.2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/11IpDRING PILINGS/BOA7-L, /,gplgTgOUSE)
I hereby certify that I O%vn property adjacent to 64--Al
Property located at
(Name of Property O mer)
r y r (IAY1 1�4f- &Iifa Al/'_
(Lot, Block, Road, etc.) on in a-Ywt(r''
(Wat�erbody) N.C.
(Town and/or County)
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 pilingslboadif}iboathouse
trust be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement
I do wish to waive that setback requirement,
_______._____ _w1v of 4 drr 3 s1� s ti•!� _- 1� _��_ agk - DESCREMON Ali-D10R DRAWING OF PROPOSED DEVE
Lop(To be flUe�d in by individual proposing developnwnt-MIENT:
(S-e� 4"gio)
ry AY a-fon ------------------
P can
f l — t�N S%Grl91U—� f
MmlmgAddress
1RParian . Owner Ynforumflon)
Si c

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to 64---Al
property located at
no"'.'
(Name of Prroperty Owner)
-r")&/.(,A
G A l �.
j (Lot, Block, Road, etc.)
on &Vql � in � il(5yi (k,
(Waterbody) N.C.
(Town and/or County)
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
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
A58 I do wish to waive that setback requirement.
-------------------- - of we' 146 &L� kA
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(A plican nfo tion n (Riparian Property Owner Information)
t-a�G��' � s�J�t,(�(lON- u �j
a�� '1`2� .

CAROLI NA BLUEWATER CONSTRUCTION
Custom Beach, Mainland, and Golf Course Homes
Complete Design / Engineering / Building
6934-9 Beach Dr. SW, Ocean Isle Beach, North Carolina 28469 [phone] �
10'-11" 1 28'-0" , 10'-11"
• 16' x 8'
Alum. Floating 12' x 12'
Dock w/ 8" Piles Boat Litt
�n<h & 8" Piles
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located in 30' Setback
(2 3Floors (H 54 SF Ea
Settbach)
ha k Linne _____________ — _
ck � �
1 I Open
II Covered i Deck I
II Deck LINIIIII
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II t—House 1Swimming AboveI
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