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Home My WebLink About66373D - Jones,LAMA / El DREDGE & FILL �t b _1 Z, ` lG1. J 3ENERAL PERMIT Previous /permit # A B New ❑Modification ❑Complete Reissue ❑Partial Reissue 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 I SA NCAC / f El Rulol attaAle W ched. it Name 2 (,l'V'U l/ d f��-�l�" Project Location: County r • %�C Street Address/ State Road/ Lot #(s) L State ZIPS --Mail Subdivision ' red Agent �jGt / (' City % ZIP 2 ❑ CW 1 EW )JPTA )#S ❑ PTS Phone # ( )�- River Basin ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body ❑ PWS: ye�.:uo> PNA y no Closest Maj. Wtr. Body f Project/ Activity length mgth ember W length ,g distance offshore_ ax distance offshore__ :hannel ibic mp_\ use/ Boatlift ne Length ;/_ not sure yes mum: n/a yes o . yes o Attached: yes o i ling permit may be required by: Local Planning jurisdiction) (Scale: 1 `/ ❑ See note on back regarding River Basin NC Division Of Coastal .Mgt. Ha b1tat Impact- Computer Sheet Applicant: • A,/"Zo �lr Date: r , r� Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code shTATAL Feet DISTURB TYPE Habitat Name I Choose One (Applied for. (Anticipated final Disturbance total disturbance. includes any Excludes any anticipated restoration restoration or and/or temp,` Dredge ❑ Fi Both ❑ Other ❑ V Vv Dredge El Fill Fill Both ❑ ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge. ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other (Applied for. (An Disturbance dist total includes . Exc any anticipated rest restoration or terr NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary Date J,- . I Z% Name of Property Owner Applying for Permit: Mailing Address: ,l / 7 e�V� AZ I certify that I have authorized (agent) �> to act on my behalf, for the purpose of applying for and obtaining all CATNIA Permits necessary to install or construct (activityl, �/;;?�/ �z !"�`' �ti� L��1 �} �;,7�t, �, ` at (my propet�y'I6c`-�q'a t)' -r- Ta /H"e ole c /;Z X / -C Bad I This certification is valid thru (date) f Property Owner Sii W ature Pate RIPARIAN PROPERTY OWNER STATEMENT 1M I hereby certify that I own property adjacent to I �7 (Name of Py6�erty Owner) property located at / fls % % t� �i J/ e (mid ess, Lot, Blo ;!d, etc. on��/��(, in , ' N.C. (Waterbody) (City/Town an 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, 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.) 11( I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Own r Inform ion) iure _ Ci � 4 Z �-d (Adjacent Property Owner Information) Signature �_--�--T---- •/--- ADJACENT RIPARIAN P J I hereby certify that I own property adjacent to I (Name/bf Property Owner) property located at i2� �� -� f (A dress, Lot, Block, oad, etc.) onG�>�,�'� r1l ,)r, , ��.�1, , in u� G/ 7 N.C. (Waterbody) (City/To n and/or County) The applicant has described to me, as shown below, the development proposed at the above location,. L I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must till in description below or attach a site drawing I Qr� K 1 %f�>t ;r 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 area of riparian access unless waived b', me. (If you wish to waive the setback, yo ust initiallhe appropriate blank below.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Ad'acent Property Owner Information) i nature* Print nr Tvnc AI me Print nr Ti Alama 1 Qz' (-W4 a le�L v V,--2 r--,v