67191D - Kelly

ICAMA / El DREDGE &FILL %
'EN ERAL PERMIT I'�1 Previous permit # A B
(New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources /( I
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached...
Name IL1 S i. IL F L (; Project Location: County �' eri !� %(,. ,
56 t:f7le°0 lw 1,;',7-Street Address/ State Road/ Lot #(s) 7 K
k-w j� 5 � 1 State /VC_ .ZIP
/U )Sz4 -y"yy E-Mail PU► S I % 4i +.
Bd Agent N
❑ CW MEW `t�PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF /❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes no
Project/ Activity
:k) length ,
tform(s)
Platform(s)
er(s)
igth
nber
k Riprap length
distance offshore
c distance offshore
annel\
is yards �t
p `.
;e/ Boatlift
dldozing
Length ' 1— f G
not sure yes
um: n/a yes t� -
yes
ttached: no
ig permit may be/required by:
.ocal Planning jurisdiction)
Jr
Subdivision `
City l:Yl.V ZIP "134-1
Phone # ( River Basin,
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale: r /
❑ See note on back regarding River Basin

NC DilVISIOn d7E �d�%l�+�J�iQ�'.#�#�64 9IIG4RisA 6aaa xasa#o..«
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scribe below the HABITAT disturbances for the application.
sheet
values should
match the name, and units- of measurement
found in. your
Habitat code
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
for.
FINAL Feet
(Anticipated fina
(Applied for.
(Anticipated final
(Applied
Disturbance
disturbance.
DISTURB TYPE
Dlsturbance.total
inciddes any.
disturbance.
Excludes any
total includes.
Excludes"any
and/(
tbitat Name
Choose One
anticipated
restoration
any anticipated
restoration or
restoration
temp impact "
restoration or
tam 1 acts
and/or temp
lm act amount
tem i.ti acts
amount
Other
-
D W
Dredge ❑
F1II ❑
Both ❑
--------------
Dredge Ei
Fill ❑
Both. ❑
Other ❑
Dredge (]
Fill ❑
Both .❑
Other
Dredge ❑
Fill ❑
Both ❑
Other F1
Dredge ❑
Dredge ❑.
Fill C1.
Fill ❑
Both ❑
: Both ❑
Other ❑
Other ❑
Dredge ❑
Fill 171
Both ❑'
Other

)ayment Proccessing Confirmation
Date Received 12/9/2016
:heck From (Name) Amy Kelly
Name of Permit Holder James & Amy Kelly
Vendor First Bank
heck Number 4366
heck amount $200.00
Multiple Permits No
Major/Minor
permit Number/Comments GP 67191D
2eceipt or Refund/Reallocated JD/2497D

\ • • • • Ut 10 9M t Aft
RIA VOR WOW]-• t1 • : • Its to \ ► : •:
Name Of Individual Applying For Permit: Q('fl 1"lM 2
Address Of Property: rJ� � _ �tl a, C Loy ay)
(Lot or Street ##, Str=t or Road, City & County)
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 proposing. A description or drawing, with dimensions, should be provided with this
letter.
/— I have no objections to this proposal.
PEPSI
I understand that a pier, dac h: mooring pilings, br..alL-water, boat house, lift or sandbags must be
srt 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' sethacL requiremnt.

4
Name Of Individual Applying For Permit: ones Am �e-&
Of Property: CJ C P&_ TO i k&_ LO��q4Address
(Lot or S6et #, Street or Road, City & County)
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 proposing. A description or drawing, with dimensions., should be provided with this
letter.
I have no objections to this proposal. -
i
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Mi%mull
I understand that a pier, da:L-, mooring pilings, breakwater, boat house, lift or sandbags 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 sethach; you must initial the appropriate blank below.)
I d6 wish to waive the 15' setback requirement.
I dn not wish to waive the 15' setca.ck requirement.

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