66639D - Lehrer

�ICAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit # A_ B
lNew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
wized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f
j� ❑ Rules attached.
it Name I C -C.� Project Location: County t , . ,
d(- 41 yytx'4 - . Street Address/ State Road/ Lot (s)
�`-1'V1 1. c�N StateW--- ZIP
'- -Mail Subdivision
_ _
zed Agent I ►�" ) c . l.1" S City `- ) V ZIP)
I ❑ Cw t�TW X PTA ❑ ES ❑ PTS Phone # ( j--- River Basin r7F-1
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body � P"f � S ��'..� (nat
El Pws: y
yes / no PNA yes,,/ no
Closest Maj. Wtr. Body wrn-'
f Project/ Activity
)ck) length
latform(s)
Platform(s)
mgth
ember
id/ Riprap length_
g distance offshore
ak.distance offshore
ibic
mp
use/ Boatlift
lulldozing
ie Length f f Sc)
not sure yes no3
rium: n/a yes
} -
yes no
Attached: yes no
nt
ing permit may be required by: 7 LA Li( ,1^
` L"
(Scale:
❑ See note on back regarding River Basin r
Local Planning jurisdiction)

NC Division of Coastal .Mqt. Habitat Impact Computer Sheet
Applicant: l IGLLGC
Date:
Describe below the HABITAT disturbances for the application.
All values should match the name, and unitsof measurement found in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FI
(Applied for. (Anticipated final (Applied for. (A
DISTURB TYPE Disturbance.total disturbance. Disturbance di:
includes any Excludes any total includes. Ex
Habitat Name Choose One anticipated restoration any anticipated re:
restoration or and/or temp restoration or tei
tempimpacts,.impact amount ternirri acts) an
Dredge ❑ Fill ❑ Both ❑ Other (�
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge[],
Fill ❑
Both ❑
Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ I I { L—
h
ME

Ate,
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
at McCrory Braxton C. Davis
Governor Director
John E. Skva6
Secretary
AGENT AUTHORIZATION FORM
Date: / C'
me of roperty Owne Applying for Permit: Name of Authorized Agent or this project:
�� r� C a �
✓ner's Mailing Address: Agent's Mailing Address:
131 —) V-- 6-141c'p H 5- 22 0,-
! f , C 7, , 1 J -C
me (YZ/)) 7
Email:
Phone (O/,/))
;rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at
s certification is valid 1 year from (date)
Z ��

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to LC— a's
(Na7 f Rpoperty Owner)
property located at
(Address, Lot, Block Ro d, etc.) 'j-pn�S1+ C_
on �� ,in J ti, r N.C.
(Waterbody) (City/Town andOr County)
The applicant has described to me, as shown below, the development proposed at the above loca
i
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 drawint
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set b,
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to v
the setbac ou 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.
(Prope ner Informa ' n) (Ad' roperty Ow formatio
Print or Type Name Pri t or ype JVame
;�/ 7 1-_5GX�2 i / /1- 21-1�i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to R ��� a L__te_ 's
(Name Pr rtY Owner)
property located at ,{/lI
/ , (Addrets, Lot, Block , ad, etc.J_
1.
on J `'t� , in c'��� N.C.
(Waterbody) (City/Town and/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)
�r- c-o14fiee
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
L, - I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
'Prope Ow r Infor Lion) (Adjacent Rrope Owner Information)
;ig Ni elA L L � &� Signature
_ Jc0224
Tint r Type Name PrWkr Type Name
1 �-2 � D� G✓ CCU " �-) . /�� / rim. � �