66336D - Lentz

ICAIVIA / ❑ DREDGE & FILL Ll-
GENERAL PERMIT Y
New ❑Modification ❑Complete Reissue ❑Partial Reissue
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
t Name
States c ZIP 1
( �l� b E-Mail _
:ed Agent / ► Ol V1 a S U+n 6 w( ✓`1
❑ CW W PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
A B
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County;
Street Address/ State Road/ Lot #(s)
Subdivision
City
Phone # River Basin V
Adj. Wtr. Body (2,, �� (t ec. fiat i
❑ PWS: A
yes [(no PNA (9/ no Closest Maj. Wtr. Body ?n1 Vy GA,)
f Project/ Activity 62-ic• - , �'- g -' , ,..
xlt���v\ �O r k G 41 U 1 V�� IZ1�\ N� VV 1�i� f- �G�� (Scale:
ick) length "I A441
V )4 1'
atform(s) l
Platform(s) 00'Y-
-
ing permit may be required by:
Local Planning jurisdiction) ,,
llr�/V� n T �1� Q �L� ❑ See note on back regarding River Basin r

NC Division of Coastal Mgt. Habitat Impact Com
Applicant:
Date: IJ /
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
FI
(Applied for.
(Anticipated final
(Applied for.
(A
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di;
Habitat Name
Choose One
includes any
Excludes any
total includes
Ea
anticipated
restoration
any anticipated
re:
restoration or
and/or temp
restoration or
tei
ternimpacts)
impact amount
temp impacts)
an
V�J
Dredge ❑ Fill ❑ Both ❑ Other
!3 , —
q d—
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ArTnA
M
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
everly Eaves Perdue Braxton C. Davis
overnor Director
AGENT AUTHORIZATION FORM
Date: / Z l
Te of Propertt Owner Applying for Permit:
,ner's Mailing Address:
Al
me Number (9/1) k2 j— V !E�d -
Dee Freeman
Secretary
Name pf Aut orized Agent for this project:
R a a41
Agent's Mailing Address.- /
a M .Ser V i S T,-- b r-, S
L j del s T=D I1' e y Al 6
Phone Number(? to) wo — 115 ?1
�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
no
certification is valid thru (date) l 3�
f 2 6/
Prop6rty Owner Signature Date
u1
o2F44e
C�

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(14OR A PIERIMOORING PII,INGSIB{OATLIP7 80A7'HOJISI.,)
I hereby certify that I own property adjacent tt3. 1 i � �,�� 's
(Natne of property Owner)
property located at
j1 (Lot, Block, Road, etc.
an J r} K �,..._. Gt .. Tt _�_. ii __..... N.C.
(Waterbody) (Town and/or County) �!�
Applicant's phone #: 1 _ ..d �'�Maiiing Address:_ �.. r S.G�t.i4';� L Y"
Ile ltas described to me, as shown below, the developrivent he is proposing at that location, and, I
have no objections to his proposal, i understand that a pier/mooring pilings I boatlifi / boathouse
nwst be set back a minimum distance offifteen feet (i Y) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
_ f do not wish to waive
a I do wish to waive that setback re uittrrient.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT:
(To he filled in by individuullrroposing dew4opment)
C-1k Piz It/
(Information for Property Owner Applying
for Permit)
Mailing Address
C ity/Sta /Gip
i'c�7110ne Nurnbe
(Riparian Property Owner Information)
K,gnat.ure
Print or Type Name
"telephone Number

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(I,OR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
f hereby certify that I own property adjacent to _& ,r. C ., 's
(Name of Iroperty Owner)
properly located at 0 6 /�! O- `��i L r j
(Got, Block, !toad, etc.2
on 1' �a .n-`a- >L� �_ ... • in _� ✓�c/f=�lJ_g o- c-- - ------ , N.C.
(Waterbody) (Town and/or County) 11
Applicant's phone Il: 1 y '�a y` J � Mailing Address:
Gkf 14;L tiC ��si�
--- -
I le has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to naive the setback, you must initial the .appropriate blank
below.)
i do not wish to waive
o I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(76 be filled ]in by individual propqosindevelopment)
Se 0 91Q- Gk f 1.t'. N
tlnturmation for Property Owner A111AN mt; tRiparian Property 01%ncr Inforn;atiou'!
for Permit)
4
'vtailiri Aci�iress ' icy �� +�

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to _IJ - t �L P vle ,s
(Name of Property Owner)
property located at CJ 6 /V o'l_V ✓ L , 5"y Lft) j� 5� /3 P 14
(Lot, Block, Road, etc.
on i3 la A e Cif Q e L _ , in 5 �a/tQ !3 d¢ c � , N.C.
(Waterbody) (Town and/or County) J /,
Applicant's phone #: �j 9 `g°Z y " � SO?Mailing Address:
/% r7 2 1 Y-a( e r G0—�T ir
/
1� L 94F/ 14i/J Al G aZ
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
S e t (!7 9v� C-k P/. /- N
-------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) C
Mailing Address ngnature
�'h
City/State/lip Print or Type Name

V^O %R %kw %A 9 IL %No ro W %A VIN# qhkw 5 1 a Aftv 9 a %* MONOW VAMP %0 8'% JI Mon Mob I%W
Approx. low
tide mark
Kayak arc I
#
13'x4'
23