66623D - Hopkins

I CAMA / ❑ DREDGE & FILL K 6
3FENERAL PERMIT
New ❑Modification [-]Complete Reissue El Partial Reissue
_ A B
Previous permit #
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 15A NCAC
�f ❑ Rules attached.
t Name 4iA" �J f �� Project Location: County
�ik.� Street Address/ State Road/ Lot #(s)
State G ZIPS
ye
E-Mail 110k0l 4, • (CAubdivision
ed Agent /y /A- City
❑ Cw AEW YPTA ❑ ES ❑ PTS Phone # ( ) River Basin i /E
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA r
❑ PwS: Adj. Wtr. Body "T�l�r,�c i ic'y�-i< (nat'/I
yes /. no PNA es''/ no Closest Maj. Wtr. Body I
' Project/ Activity
(Scale: / i,
ck)length
itform(s)
nber
i/ Riprap iength
distance offshore
x distance offshore
Length +�
not sure yes
um: n/a yes f�
yes • n ,
atached: •qe;, '_ no
ig permit may be r red by: �./ r f 7� ❑ See note on back regarding River Basin
_ocal Planning jurisdiction)

NC Division of Coastal ,Mqt. Habitat ln>a actComputer Sheet
Applicant: 6 A
Date: 7 z
Describe below the HABITAT disturbances for the application.
Ali values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq: Ft. FIRIAL Sq. Ft. TOTAL Feet FII
(Applied for. (Anticipated final (Applied for. (Ai
Disturbance Total disturbance. Disturbance dis
DISTURB TYPE includes any Excludes any total includes . Ex
Habitat Name Choose One anticipated restoration any anticipated re:
restoration or and/or temp restoration or ter
tempimpacts).—impact amount tem im acts art
Dredge ❑ Fill ❑ Both ❑ Other
3�
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �G i 's
a (Name of Property Owner)
property located at �" --I>r,
on �� J ,)� (Address, Lot, Block, Road, etc.)
y in __� r - ' N.C.
(Waterbody) (City/Town and/or County)
1 The applicant has described to me, as shown below, the development proposed at the above
loca�io
I have no objection to this proposal.
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, boat ramp, breakwater, boathouse, lift, or groir
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive 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.
(Proper"w formation)
r
Snature - 4/ 4 ; ^
Print or TvAe Name _
(Adjacent Property Owner Informatio )
ture
GC { M v n 5
Print or Tvne Name

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: ,0 .r-
Address of Property: i �` k '�'' • S "--
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:' --
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 pro osing. A description or drawing with dimensions must be provided with this letter.
Z/;nhave no objections to this proposal. I have objections to this proposal.
Ifyou have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp://www.nccoastalmana-qement netlweblcmistaff listing orbycalling 1-888-4RCOAST.
No response is considered the same as no objection If you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish t aive the setback, you must initial the appropriate blank below.)
-1117 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Own nformation)
C�
Signature v
Print or Type Name
, 7- /— -i -i- , sz X�--
)arian Property ner Information)
�( IIJcv
In
Print or Type Name
OAnl1:..... ArI__ -

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