66582D - King

i4MIIA / []DREDGE & FILL � l ` `� 6658? � A B
- -39NERAL PERMIT Previous permit #
(slew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources II C,
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ' I� I Q
I � 2 ❑ Rules attached.
t Name ` I' V `Ol �1� Project Location: County (DC,'h �Nl Imo.
Street Address/ State Road/ Lot #(s)
State t� L ZIP n �� �� i x C C R 1'1 ✓ G1 A-C
O Mail
ed Agent �AJ-i 1' -� S p I
❑ CW JA El ES ❑ PTS
❑ OEA /� EW ❑ HHF /�❑ IH ❑ URA ❑ N/A
❑ PWS:
yes / no PNA
Project/ Activity
"-J I ;CceSs
:k) length X 3 3
ttform(s)
Platform(s)
igth _
nber
I/ Riprap
x dis a offshore
anne
d ds
se/ Boatlift_�
yes /
i ✓� rW
v G1 HIT; +( vv-\ Vr r (a
Subdivision
City;-4 r' cl�:V� I�jf l ZIP ��gI
Phone # ( ) River Basin k"M 4
Adj. Wtr. Body Cain Gknat
Closest Maj. Wtr. Body Alvyw
aU014avlJ 44 co�nS�w(� C"
X i n\-A� W c(��' a (Scale:
not sure yes
I
um: n/a yes
--
yes no
atached: /yes ono
ig permit may be required by: ' o W Y �`/^� ' O V � 4A (A ` ❑ See note on back regarding River Basin r
.ocal Planning jurisdiction) _ I 1 N
- - - - -- - r% I I I � I \ _�n

NC Division of Coastal Mgt. Habitat Impact Com
Applicant: 0 ( C � V"
Date: 0 5 4t Ao l 4
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
(At
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ter
temp impacts)
impact amount)
ternimpacts)
arc
6
Dredge ❑ Fill ❑ Both ❑ Other 0
a T
a � g
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
Dee Freeman
Secretary
AGENT AUTHORIZATION FORM
Date: _
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Owner's Mailing Address:
Agent's Mailing Address:
SS-140 L �4 tjC
Phone Number (91 r'>j 7 V 11 S�SE Phone Number
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at 1 c� / 6 e-Eb r -
This certification is valid thru (date) (P I
Property Owner Sign ure Date

ADJACENT RIPARIAIN PROPERTY OWNER STATEMENT
(FORA PLER&IOORING PMWGSaOATLUTIBOATSOUSB)
I hereby certify that I own property adjacent to k is
(Name of Pro Owner)
property located at _ Z! ) C; ,� t�5t .e� T)
f .(Lot, Block, Road, etc.)
n
on l_ci r-\ c l� , in C� �. e-►� ��_C "-� , N.C.
(Waterbody) (Town and/or County)
Applicant's phoni6* 2 1 C 74L,SSMafag Address• { t�cJl
3
He has descnbed to me, as shown below, the development he is proposing at that Ioca- ion, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlifr / boathouse
must be set back a minimum distance of 0een feet (15D .from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate b auk
below.)
��' I d, o not wish to waive
I dq wish to waive that setback requirement -
DESCRIPTION ANUOR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�S
(Information for Property Ow7aer Applying (.Riparian Property Owner Information) for Permit)
Mailing Address Signature
l� i J c-: a��-
City/State/Zi Print or Tym Name

ADJACENT RIPARLOAN PROPERTY OWNER STATFMNT
(FORA PZER&OORNO PI UNG& 0ATZ,umlmAmousv
I hereby certify that I own property adjacent to _
Name ofP Owner)
property located at )Z
.{Lot, Block, Road, etc.)
on ,, , m _ C1 o ln
(Waterbody) (Town and/or Count})
A Spiicaa s phoa� #: � ! C 7 �U 55 Aatdress: g I ( A
fie has desmx to me., as shown below, the development he is proposing at that Ioeaki
have no objactions to his proposal. I uudemstand that a pier/mooring pilings / boatM I boathouse
must be set back a minimum distance of fifteen feet (15D .from my area of ripadau access unless
waived by me. (1f you wish to waive the setback, YOU must initial the appropriate M�auk
below,)
I do not wish to waive
A4L I do wish to waive that setback requirement.
• DESCRIPTION AND/OR DRAWING OF PROPOSED DEVMOPMENT:
(To be flUed in by�imavidudproposing devefoprnmo
fA �Cyt
(Info --don for Property Owner Applying
for Permit)
Ci�y�sti;t�rz
r'. .
(Riparian Property Owner informatxen)
Signatare
iat or ' Name

13x13 I)
Proposed Lift II
Existing Structures
n--� N
Sx16 Float II
UP
II
20x18 Dock
CANAL
z._8.
II II II ��
jam_
u 45'-13/4• 116x5 Pier li
t 121 SCOTCH BONNET DR. Perry Lanning
met Dr. MAC, KING 125 Scotch Bonnet