65101D - Marchetti

ZCAMA / ❑ DREDGE & FILL
PERMIT
Previous permit#
7�ENERAL
❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC !
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Name �L ( U, 6
❑ Rules attached.
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Project Location: County
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Street Address/ State Road/ Lot #(s)
`-'iY� State�ZlP� (
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(li) 1 Fax # ( )
Subdivision
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edAgent �t ^�+11(tV LY'�1r�1_k,,Ad/yt(;�i�X�`
pityr ZIP C
CW gEWA ES ❑ PTS
,,,Phone # O River Basin (1
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (\w
❑. PWS: El FC:
( am,�-
yes no PNA yes /1no Crit.Hab. yes / no
Closest Maj. Wtr. Body Hay\j V V
Project/ Activity
:k)length 5 x
(s) V-
ci-t
er(s)
igth
nber
I/ Riprap length
distance offshore
K distance offshor
annel
is yards
ip
;e/arlilldozi
Length f
not sure yes
not sure yes
im: n/a yes
yes
ttached: yes
g permit may be rcyu" CU „ y, 4,Af V %,V V I 11'A w A
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L_J aee note on back regarding Riygr Basin, t
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NC Division of Coastal Mgt. Habitat Impact Computer ,sheet
4pplicant: Permit #:
Date:
describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
'ound in your Habitat code sheet.
iabitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated fina
disturbance.
Excludes any
restoration and/c
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ OtherLl
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Dredge ❑ Fill ❑ Both ❑ Other
V O
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 El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

?Name of Individual Applying Fog Pertnit: K (A a- r c_k e.
Address of Property 1 S 13
(Lot or Street lit, Strut or Road)
Ciry and CotMty)
hereby certify that I own property adjacent to the above-mferencea propc,.Ty. The iindividu+
applying for this permit has described to me as shown onthe aanched drawing me dewloptrivaftte
are proi+osing. A des ion of dtawing. with dimeaslons, should be crovided witfi thk 1eiter
T have no objections to this proposa;
If you have objections to what is Wag proposed, please wrtre the D1%is1-.,n of Cow
Management, 127 Cardinal Drivo Utswioa, Wilmington, NC 28405 or salt 910_796_71
within 10 days of recaipt of this notice. No response is considered the some as no owect6n
you have been notified by Certified Moil,
WAMR SECTION
i uaderstand that a pier, dock, amoring pilings, breakwater, bout house or boat iift anw*bv
bck a minimum distance of 15' from my area of riparian access - un:ess %vaived b. me. (if y
wish to -svoive The serbock, you must initial the appropriate blank betow
do wish to waive the 17' setback reovirer-
i do not vlsh m waive the i5� setback -ea::i►eT--
an Arip r �►te

Name of Individual! Applying For Permit~ V-; c}-rs- K m a r-- c_k r✓4 ;
Address of ProvmM IS 2,3 5 %e I P A rA
(Lot or Street A. Scmt or Road)
(Ory and County)
hereby certify that i own property adjacent to the above- rrferencea property. The individva
applying f0t this permit has described to roe as shown on the aaached drawing the &vtkWnent*'-�
are proposing. A descrim on or drawing, with dimensions, should Et crovided wir* fts kt}er
have no objections to this proposa;
it' you have objections to what is being proposed, please write the Di%lsli,n of Coftq
Management, 121 Cardtaal Drivo Extension. Wilmin;ton, NC 28403 or call 910-796-7Z1!
within 10 days of receipt of this notice. No response is considered the some as no owectlonI
you have been notified by Certified Mail.
W,kMR SECTION
I uaderstund chat a pier, dock, mooring pilings, breakwater, boot !souse or boa: lift mtt►stksr
bck a minimum distance of 13' from my area of riparian access - unless Nrsived b. rite. (If yo
wisb to waive the setback, you must initial the appropriate blank betow
do wish to waive the 13' setback read►er
i do not wish to waive the 1 t' setback
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