66570D - Greer

fCAMA r ❑ DREDGE & FILL \L�/ I ��E/" A B
3)ENERAL PERMIT \\ l Previous permit #
New ❑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 15A NCAC
Name z Zoe-enC / n! /'fe Project Location: County /tl<�✓w �Y
6y 1V 4 Ar6 . rl be
yore State Ve ZIP W8412q
(V) 2 32 -2 E-Mail
ad Agent
-
❑ CW
0115W
LzSPTA BES ❑ PTS
❑ OEA
❑ HHF
❑ IH ❑ USA ❑ N/A
❑ PWS:
(es / Oo
PNA
/ no
igth
nber
(distance offshore
annel
is yards_
P
,e/ Boatlift
Length
not sure yes ( 9�
im: n/a yes
yes > no
ttached: yes (9.
Street Address/ State Road/ Lot #(s)
& 6 2 q e fry`
Subdivision
City /r r%f t�f+?P ZIP
Phone # ( ) —"` River Basin
Adj. Wtr. BodC-s9 nat /r
Closest Maj. Wtr. Body �
g permit may be required by: A111 ep- Of . ❑ See note on back regarding River Basin
ocal Planning jurisdiction)

NC o1visil'g n of Coastal r1glt, Habitat Impact computer Sheet
Applicant:
Permit #:�
S 7
Date: 5 Ajf//�o
Describe. below the HABITAT disturbances for the application.
found in your Habitat code sheet.
All values should match the name, and units of measurement
Habitat blame
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
Includes any
anticipated
restoration or
temp impacts)
FINAL.
(Ant0ipe
diiQl
Exdud
Ob
an410
im
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
��
U
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Ell ❑ 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 ❑
hrcAno n Fiil f 1 Both n Other ❑
Sq. Ft,
TOTAL Feet
for.
tINAL I-r—
(Anticipated final
ited final
(Applied
Dance.
Disturbance
disturbance,
as any
total includes
Excludes any
and/or
ration _
any anticipated
restoration
temp impact
rtamp
restoration or
,2-4�;'
/ Z

4
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to )r/6 re&,e 044-e- t; (*eP i 's
i / h . J, , , 1 19 l (Name of -Property Owner)
property located at .(pL2 Z Old
on Vn� I . (Address,
v ,k , in
(Waterbody)
�4 ti /lhjv fnlar, N.C.
(CityfroWn and/or County)
The ay_p1l6ant has described to me, as shown below, the development proposed at the above location
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bacH
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wai
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.
Ow info ion) (Adjacent Property Owner Information)
ature Signature
or Type Name_ _ , Print or Type Namey ,�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to rUI's
/ (Name
of Property Owner)
property located at
�Uftddress, Lot, Block,t�oad, etc /on UC f � f}� , in - t -CIA\/N� ?Uety �fffrUduer—, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waiv(
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.
(Pfys'gerty Owner
t or Type Name I
(Adjacent Property Owner Information)
Signature
Print or Type Name ,

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