67149D - Lee

C^MA / ❑ DREDGE & FILL `..
GENERAL PERMIT �� `s A B
Previous permit #
+4ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources j
;oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC00
_ /� _ , Q / ❑Rules attached.
Name O 1 T W'�' Project Location: County �j -yimS �V►Z
V
rJ ITYY °tA-J[/� Street Address// -State Road/ Lot #(s)
iA�DA State_ ZIP i !�6 C�U�' '►'�5'ii�r-D �'-
ft)'99'-Cl " E-Mail r ,\- Subdivtissiion � " ""
:dAgent 1-eL ao' Y kdo' G ' City fi_%U�CK/ri �j A l ZIP��
❑ CW g(Ew PTA ❑ ES ❑ PTS Phone # ( i �) �'�� J River Basin I�
❑ OEA '❑ HHF ❑ IH ❑ URA ❑ N/A Adj. Wtr. Bod(nat
❑ PWS:
res / no PNA yes / Closest Maj. Wtr. Body. fes / Fw
Project/ Activity
P
e/ oatli 1� i 1
Length
yes (Y
ttached: 6s, no II_!1
ig permit may be required by:
.ocal Planning jurisdiction)

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: � - a Permit #:
Date: Up
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
Choose One includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/ortemp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/o
temp impact
amount)
(Jt,�
Dredge ❑ Fill ❑ Both ❑ Other
l
��
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 ❑
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 ❑
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CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
j
ame of Property Owner: 7 6` �— Le c
ddress of Property:
(Lot or Street #, Street or Road, City & County)
pplicant's phone #: -1 10 �� Z - 7 (�, 9 Mailing Address:a .t} rra wh eaol i�
hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe
is described to me as shown on the attached drawing the development they are proposing. A description of draw
ith dimensions must be provided with this letter.
01'si I have no objections to this proposal. I have objections to this proposal
.you have objections to what is being proposed, you must notify the Division of Coastal Management (DC.
i writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
lilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response h
)nsidered the same as no objection if you have been notified by Certified Mail
WAIVER SECT109
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distanc
5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
)propriate blank below.)
_ I do wish to waive the 15' set back requirement. Do
I do not wish to waive the 15' set back requirement.
'roperty Owner Information)
ignature
a-(+ (et
rint or Type Name
rme
UJ n
10� -
MparippanProperty Owner Information)
i
c' !!,
Signature
Print or Type Name
%Ly _ D .S . C i-1 L 1 P, C�t i
Mailing Address
iailin dress
�; h W 7V 2,?J�

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ime of Property Owner: 70. r+ Llee
]dress of Property: �re,
CV
�j (Lot or Street #, Street or Road, City & County)
?plicant's phone #: I I�` ©" � '�3 Mailing Address: /00J 1 ' -CCt3 �;o
OW4.. NC- a3z"
iereby certify that I own property adjacent to the above referenced property. The individual applying for this pe
►s described to me as shown on the attached drawing the development they are proposing. A description of draw
ith dimensions st be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
you have objections to what is being proposed, you must notify the Division of Coastal Management (DC:
i writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive'
lilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response i.
)nsidered the same as no obiection if you have been notified by Certified Mail
WAIVER SECTI09
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distanc
S' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
:)propriate blank below.)
. 0(1— I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
Property Owner Information)
signature
1 a (+ Ue-
rint'or Type Name
loa vq. moo kftd iJr.
Aailin
�1Address
_ I k 1i-7n-7--1P'
rnUs+ � n; � J -onl�
(Riparian Property Owner Information)
4N l,./ ' (l r-C ram. V
Print or Type
perk �r� C—,n!' e,
Mailing Address

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