67163D - Howard

�CAMA / ❑ DREDGE & FILL s/ ;�2 A
6,� A B
3ENERAL PERMIT Previous permit#
KNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
wized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1'C• T.0
n� a ❑ Rules a ed.
it Name J Y�,; (� W �v� Project Location: County I&ANNS 11A/d rn
5 i 1l/ �0 v -t� Street Address/ State Road/ Lot #(s)
61 State ZIP
(��g) �c' �13 �� ��" E-Mail — Subdivision l �—
ted Agent City, T Gam_�C �l' ZIP_
❑ CW QEW PTA ❑ ES ❑ PTS (Phone # ( ) 1 i G `� L{ b• b� 1 b River Basin WV
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body A l (nat )
❑ PWS: l � /1 .
„_, _ _ _ , �� Closest Maj. Wtr. Body VV Al Vl
,f Project/
I\ ;1
>ck) length_
'latform(s)
Platform(s)
pier(s)
ength
ember
ad/ Riprap ler
ig distance o)
iax distance/c
:hannel /
Length ) b
not sure yes
um: n/a yes
yesi
r
\ttached: ;yes no
ng permit may be required by:
Local Planning jurisdiction)
_.- A ►� .,
❑ See note on back regarding River Basin
L, i..,,.0 -

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: )Vw 6n Wv w c,, -d Permit #:
Date: o 6117 /M1 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.
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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
ow
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 171 Other ❑

Nom Carte ID140 Igte of E entad loft td Phocumm
Ead". Govamor :a!!IR li. So�i►�Oiwdos
i�tltOr';' �g0lf� Co11uspt ��OIIIII
` is hooWn Suftdnd io ad on*w b
Mer M cfAw tt - .
vbtoin zav CAMA pefitbN reined for so Pvooft ftftd boom The surtwftMlia - is
dosed in the a4u~ aketch
ON OF PROJECT:
�Tr
�/al���✓ /����'f/, A/c"-
S_
e at ftwe ►Y owner.

�07/2004 19:26 9108429806 GREG HOLDEN
PAGE 01
Name of Individual Applying For Peralt:
Address -of Property:
I hereby certify that I own- property adjacent to- the above-
raferanced property. The individual applying for this permit has
described to me as sbown on the attached drawing the davelopuent
they are proposing. A. description or drawing, with dinenz:Lons,
should be provided with this letter.
I have no objections to this proposal.
I understand that a pier, dock. mooring pilings, braa)6rater,, boat
houses, lilt _ must be not back a =ininm distance of 151
from my area of riparian access itramm waived by se. : (If you wish
to waive the setback, you M&L initial the appropriate blank
below. )
Ido wish to waive the 15fsetback requirement_
I do not Wish to waive the 15'setbeck requirement.
or
�
mate ''�%

tAISCHOR
Q�tme of Individual Applying Fc_ It (/1
idress' of Property: flo
�,I�
(Lot or Stre•t ree E. road, City & county)
hereby certify that I own- property adjacant to the above-
aferanced property. The individual applying for this permit has
ascribed to ae as shown on the a-ttachad drawing the davelopeent
hey are proposing. A description or drawing, with dimensions,
hould be prow ad with this 2ettar.
I have no objections to this proposal.
L understand that a piez-, dock, awo:ring Pilings, brmakvatsr, boat
r1ous a, lint _ must be set back a mi.nis<am distance of 15'
from any area of riparian access unless waived by me. (If you wish
to valve the setback, you NMI& initial the appropriate blank
below. ] -
do wish to waive the 15'satback raquireysent.
I do hot wish to waive the 151setback requirement.
Signature ,J
prx.n M

Q Iv
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