66556D - McCurry

CAMA / ❑ DREDGE & FILL
A B
IENERAL PERMIT
/ Previous permit #
New ❑Modification ❑Complete Reissue ❑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 Rules attached.
Name \Cl�' 1' ( l�Y��� Project Location: County � ) 'AJn 5 V" ' l
(C, C j� . Street Address/ State Road/ Lot #(s)
leck � �� tC e ({ State ,N ( ZIP a�� �i M i I'� I� n J� .
Subdivision
edAgent cityfZIP U�
T--
❑ CW *TA ❑ ES ❑ PTS Phone # ( �i River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body C na
ElPWS:
,�., Closest Maj. Wtr. Body
yes / (no i PNA yes ro)
r Project/ Activity 1
ck) length
atform(s)
�ngth r
amber
A/ R�rap length_
g d' lance offshore_
distance offshore
ibic yards
mp _
use/ooadi 3
not sure yes
i-V�WkV U \ OV O\
(.) -fir- 2X
>rium: n/a yes (fin J f
yes no
Attached: yes no
ling permit may be required by: �`1vv� �J T l/lX�� ! 1 T �
Local Planning jurisdiction) l , j
k
(Scale:
❑ See note on back regarding River Basin
1-1 L— i ,-.' .,

NC Division of Coastal Mgt. Habitat Impact Con
Applicant: /V 1t C�� (VK\I
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
F
(Applied for.
(Anticipated final
(Applied for.
(,
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
d
Habitat Name
Choose One
includes any
Excludes any
total includes
E
anticipated
restoration
any anticipated
n
restoration or
and/or temp
restoration or
b
temp impacts)
impact amount)
temp impacts
a
v v
Dredge ❑ Fill ❑ Both ❑ Other
I
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A P.iER/MOORING PHJNGS/BOATUFTBOATEOUSE)
I hereby certify that I own property adjacent to M01A.1 t' Y ICY i ,nnl s
(Name -of Property Ownef) - -
property located at _3� f a'1 f 0Q !�t
(Lot, Block, Road, etc.)
on in &= Ut N.C.
(Waterbody) (Town and/or County)
Applicant's phone �P Mailing Address: ZA
Vu
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 (I 5) 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 PROPOS 1) D OPMFIV :
(To be filled in by individual proposing development)
171 A '� /r
�wn•e�,r'S ��C�Jc � `�%�v,-�y`s� �o� �l,e ��,��ES- 3,�z :v�
PX
y
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
3� MonroQ a
Mailing Address s4 ature
fib I to . �n �,►II_Q i)� , c.,

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PM MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to , I(+kou-1 W'Uwd 's
(Name -of Property Owner
property located at 3
on
(Waterbody)
(Lot, Block, Road, etc.)
in 02 f 0m 161(&Aj� , N.C.
(Town and/or County)
Applicant's phone##: 41 t)- M . _%%Mailing Address: �l.lsdlL -
--� Ids h,�UC ag��
He has described to me, as shown below, the development he is proposing at that location, and, l
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
W�L I do wish to waive that setback requirement.
------------------------ -------- ----- ___..__--__ -
DESCRIPTION AND/OR DRAWII\'G OF PROPUS?✓D DEVIMOPMENT:
(To be filled in 0 individual proposing development)
✓ � g ✓v✓'� �£i1� �,J��� �i } A*X+
Floc��� J0.0CJ<(iq,C.,jrr7�5�
��ro�e ray Nlc�vt� P��PF✓� y
Oro '
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address n Silgnature
--�

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