67221D - Harrell

ICAMA / ❑ DREDGE & FILL Kll�
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J- A B
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑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 J 1 �-f . 1 2.W
❑ Rules attached.
Name Project Location: County
�^ �`,►�� ��-- Street Address/ State Road/ Lot #(s) �--- [
State- ZIP c� L1 U t�
E-M gaill Subdivision
sd Agent�City {` ZIP
❑ CW YEW XPTA ❑ ES ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 0 9ftMooky "ie" St
❑ PWS:
yes ro`) PNA yes / no Closest Maj. Wtr. BodyT� /-
.M•. _.►
: l
'■,■■■■ :,T1.1it � ITMOSEN\ ■■ MM
■■■W%0■�=■ Iliilii/J■ilr�li■1�■�■■■■■■■
igth
nber
I/ Riprap length
distance offshore
x distance offshore
annel
iic yards,
ip
se/ 6oadift t i X I I,
illdozing
Length _(4
not sure yes
ium: n/a
es o I=--
_
MIL! 2 4. i,
ig permit may be required by: � L—m% n-C nn� 14�n+n El See note on back regarding River Balm ri
Local Planning jurisdiction)

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant��
/�
Permit #,
f
Date:
�-Y
Describe below the HABITAT
disturbances for the application. All values should match the name, and units of measurement
Found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temo impacts)
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 ❑
Dredge ❑
Fill ❑
Both 0
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: K/
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
CIZ-_ JJ L
row
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at --V
in W /C County.
r
Q - 100 N-a Ld 5 l3c.,h �L j3//d
CDC-ScitAI WA)
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Info
ma
Print or Type Name
0 ()tee r
Title

Name of Individual Apptyikg For Ptertit:..Ja'c' o Y)
�
Address of PrcpeM 4
i Lct or street A. sheet or Road)
DAT�IaMl, N(G BrvaswicfC
'City and Cowry)
hereby certify that I own property adjacent to the above --referenced Prope:-v. The individual
applying fOr this permit has described to me as shown on the aaached drawing the devekWty #y
are proposing. A description or drawing. with dimensions, sholild be *roesided with this letter
' have no objections to this ronosa;
J P ,
if you have objections to what is being proposed, please wrtrt the Di%isi-ten of Cofer
Management, 127 Cardtaal Drivo Utsnsion, Wilmington, NC 28405 or c:►li 910-796-72i5
within 14 days of receipt of this notice. No response is considered the some as no obi Ltion if
you have been notified by Certified Moil,
WAIVER SECTION
i understand that a pier, dock, Mooring pilings, brtmkwater, bout house or boa. lift aM1ks#besei
bcka minimum distance of Ia' from my area of riparian access - unless Nraived byou
'isb to lv3ivt the setback, you must initial the appropriate blank below
VL . do wish to waive the l 3' setback reauirer-e--
i do not Wish to waive the i 3* sctbaci:
zn rvt
Date
)0".'- 1� VF -L� li

? i i'3,T5 i
?dame of individual Applying for Permit: ---Jason (�
Addmm of Property
-Lot or Street: it, Smeet or Itoedl
Lai- Ls-("d a2g4oS Poru-riwu
'Ciry and CoWry) -
hereby certify that I own property adjacent to the above•referencea proper:y. The individ"
applying for this permit has described to me as shown on. the anached drawing the devek*nw *ey
are proposing. A descrintLon or drawing, with dimeaslons. should be crovided with this kt4er
have no objections to this proposa;
If you have objections to what is being proposed, please wrtrt the Di%isjun of Cor;siM_
Xanagemen; 127 Cardinal Drivo F.utenaion, Wilmington, NC 28403 or Call 910_796_72.15
within 10 days of receipt of this notice. No response is considered the some as ne oblecriDnif
you have been notified by Certified Mail,
WAMR SECTION
i understand that a pier, dock, ttr`ooringpilings, brtmk%Ynter, bout house or boat lift tnuatw set
bck a minimum distance of 15' from my area of riparinn access - uniess Nraived b% me. (if you
wisb to ,vnive the setback, you must initial the appropriate blank below
do wish to waive the 15' setback rent:irer -I
i do not Wish to waive the 13' sctbacl<
C� r �, �Vc-n % ZV J (P
? an � r �.►ta

Rm mican Rsn Company
w P.0 Sox 11046
Souchoort. North Carolina 28461
Email: AFC036000ao1 com
;NVOKE NO M
(.9101457-5488
10) 457-6551
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