66399D - Howell

LAMA / ❑ DREDGE & FILL 1(� L SX3 �6 NOO 66399 A B
Previous permit #
GENERAL PERMIT Date previous permit issued
-
,lew ❑Modification ❑Complete Reissue ❑Partial Reissue P P
zed by the State of North Carolina, Department of Environment and Natural Resources p•, ��
>astal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑Rules attached.
Name>na. {� L{ (% kutl'i rt Project Location: County ~�
�'t Street A��dddress/ State Road/ Lot #(s)
State V ("Y1�
Mail ' ~ Subdivision
W Agent Yl; City �'A'ver
❑ CW �E11I/ PTA ❑ES ❑ PTS Phone # (} j� Basin/
❑ OEA /0 HHF ❑ IH ❑ UIBA ❑ Wp► Adj. Wtr. Body + ,- ►— ate
Closest Maj. Wtr. Body
yes no PNA ( yes no
Project/ Activity
ck) length_
atform(s) j
Platform(s)
ngth
tuber
d( Riprap length_
g distance offshore_
w distance offshore
hannel
ibic yards
mp
use/ Boat
3ulldozing
I 1
ne Length
not sure yes �,no
I
)rium: n/a yes /no j
yes /no
Attached: yes
4 I j
ling permit may be required by: J I 4
(Scale: ' !
❑ See note on back regarding River Basin
C..
1 i..- 1 Phnnina Iiiricrlirtinn)

NC pivX! n Of COastal .M9t. Habitat Impact* computer Sheet
Ite: 3
;scribe below the HABITAT disturbances for the application.
d sheet
values should match the name, and units of measurement found in your
Habitat co . e
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
for.
FINAL Feet
(Anticipated fins
(Applied for.
Disturbance.total
(Anticipated final
disturbance.
(Applied
Disturbance
disturbance.
DISTURB TYPE
includes any
abitat Name Choose One
Excludes any
total includes .
any anticipated
Excludes any
restoration and)
anticipated
restoration
and/or temp
restoration or
temp impact
restoration or
-�.
a,..,....1,*—fie%
nmmintl
Q 14—)
Dredge ❑ Fill ❑ Both ❑ Other
D
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ElFill
ElBoth
❑
Other El
Dredge. ❑.
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other El

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit:
Mailing address: IN t� n k /
e'u/5
Phone Number: (U - 3 f -7
I certify that I have authorized lai Ji,
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at �C" t �,
in
County.
This certification is valid through
i
Date
(Property Owner Information)
_2�u . k"K,
Signature
oIq `el
Print or Type Name
wee P�-
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I. L
(Name of Property Owner)
I
property located at
/(Address, Lot, Block, Ropd, etc.)
on ��, 1-rq /<ff , in �tg t a S �- ' I , N.C.
(Waterbody) (City/Town and/or ounty)
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, boat ramp, breakwater, boathouse, lift, or groin
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. (�
(Property Owner Information)
or Type Name,
(Adjacent Property Owner Information)
re * f
rint or Type Name

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
r
(Lot or Street #, Street or Road, City & County)
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 "sing. A description or drawing with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you 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 at http✓/www.nccoastalmanagement.net/web/cm/staff-listing or by calling 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 to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback. requirement.
(Property, Owner Information)
Signature
Thr9 /,Wi
Print or Type Name
(Riparian Property caner Information)
i ature
4V .
Print or ype Na
i'

&%w ,- ub-A
I it
IR&
^ 1�
.41
N
• n
i, ,
r
4+7v pic M" a�3 as�,�. r • #'
ie
dd y k
�tlA6y I �� iM 'B 51 �� fY ,•,�p. x
"1L d 4 $ .
� t• a. rpd 5�. P � '� .
F ��ee •
� r:. a 'm

��z
-7J