66653D - McKinnin

tC AMA / ❑ DREDGE & FILL
'ENERAL PERMIT
Previous permit# A B
1
INew []Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources 7
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ' ' i �✓
El Rules attached.
t Name n h r Project Location: County ►'c: k
f 1 {{
�l Street Address/ State Road/ Lot #(s)
IV State ZIP A
( Subdivision
ad Agent city, S S ' 4 v\CA ZIP L t )
❑ CW ) (EW XPTA ❑ ES ❑ PTS Phone # ( River Basin
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ WA a ' " .
Ad'. Wtr. Body�, A� nat /r
C PWS: _ I � fib
yes / fno, PNA yes / o Closest Maj. Wtr. Body '`�T/L-�,/-«�'
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Permit #:
Date:
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
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
I temp impacts
amount)
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 ❑ 1
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill 171 Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: r mot(c� inv101'\
Mailing address: C/o 1��+ v\ f �i hKcq'�
gS Cf C'qr+[c2o_v_Lt�'t ; NZ'Y_-�It-,
_913
Phone Number: S�7 aZgg-��SCe
I certify that I have authorized A I�k;�
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of IQ-1- A'�
at my property located at
v
in n:k_ County.
This certification is valid through /yO V�_.�, c� �
Date
(Property Owner Information)
-.Z, //,
Signature
Print or Type !Name
Title
al�L� I Z-vL(�!

COASTAL MANAGENENT
Name of Individual Applying For Permit: C)n I t� I C
Address of Property: ;'7, ce r
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced.property. The individi
12"" /1 f +hoc per b.� /�(•..C..r.Ci%ari+nrreas eu^..r... n +l- K,...i+aa ♦L., 1_.--
! trig .or t d rw a has •av v ♦aw as 1A1V Yru Vr�l LLtV 0.uabllbLL dl GtW lllb' u1G deYG�uprt�ent i1
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa;
Management, 127 Cardinal Drive Extension, Wilmington, NC 28.405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu;
set bck a minimum distance of 151 from my area of riparian access - unless waived by the
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
t// I do not wish to waive the 15' setback requirement.

DIVISION OF COASTAL MANAGUENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVERFORI�r
Name of Individual Applying For Permit: 1),7 JHk
Address of Property:' C, n
(Lot or Street #, Street or Road)
0 ►g k �Lj C .
(City and County)
I hereby certify that I own property adjacent to the above-referenced.property. The indh
applying for this permit has described to me as shown on the attached drawing the developmen
are proposing. A description or drawing, with dimensions, should be provided with this left
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Ci
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910.395
within 10 days of receipt of this notice. No response Is considered the same as no objec
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift m
set bck a minimum distance of 15' from my area of riparian access - unless waived by n
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' setback requirement.
A . 1

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