66521D - Nanney

�CAMA / ❑ DREDGE & FILL V r-
sPrevious ENERAL PERMIT �� ' A B
permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
irized by the State of North Carolina, Department of Environment and Natural Resources r
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC l
Rules attached.
it Name A2Vya O WCUAV\(V Project Location: County tyy w-,V, " L
k1
151�41C� State ZIP U
E-Mail
Eed Agent
❑ CW P'EW ITA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
yes ( no PNA (yes /)no
f Project/ Activity
ock) length
latform(s) _
Platform(s)
:ngth
amber
d/ Riprap length
g distance offshc
ix distance offsh
hannel
bic yards
np 0
ise/ Boatlift it
ulldozing
e Length
not sure yes no
•ium: n/a es no
Ges; o
4ttached: yes no -
ng permit may be required by:
Local Planning jurisdiction)—`,
Street Address/ State Road/ Lot #(s)
Subdivision f 1
ptyM tc i'A 2 ZIP
��hone# River Basintn
Adj. Wtr. Body SGwoL
Closest Maj. Wtr. Body AJ L,�W
(Scale:
❑ See note on back regarding River Basin r
1-7,v. A .. .1 n 0I L j V - 1­-1. i r1 . I. .. _.

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: V' GL V1 h e r Permit #:
Date:
to
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
found in your Habitat code sheet.
Habitat 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 fin
disturbance.
Excludes any
restoration and,
temp impact
amount
j�
V
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Nth Carolina De R
partment of Environment and Natural Resources
aeveriy Eaves Perdue Division of Coastal marjageme ii
Gomm James H. Gregson twee Freernan
DiwAx-gwewq
GEN UTHQ p
Date:
am n of Prop�y pr,r�r gi�h►in9 for Permit: Name of Authorized agent for this
projecL
1 1
� � L
aners Mrelling Address
I
'one Number70`f
Agent's Melling Address:
AJ, <,
Phone Number WO) AL,'7 rY? -4 <—
artify► that i have auth(xiied the agent listed above to act on my behalf, for the
and obtaining an CAMA Permits Purpose of applying
1�� to install or construd the following ( ty).
I Property located) at _/ U7 5 c�-) /
s certification is valid thru (date)
04 41.9 2airo
Property Owner Si tore
Dais

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T9, r

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PLFAz 0OBMG PH"G&B OATLLII /B OATHO USE)
I hereby certify that I own property adjacent to�7(�- 'S
.(N me of Property Ory er)
�.
property located at) 0-7 S (;��� (D S
.(Lot, Block, Road, etc.)
on C_c.Y1 c �c ,iI1 ��iC_�,IC'��� ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone#�Qy-ZL�^?�$3i� MailingAddress:I(�-7
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 xne. (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)
(Information for Property Owner Applying
for Permit)
Mailing Address
City/S2ate/Zi�9
(Riparian Property Owner Information)
Signature
Print or Type Name

Canal
II
II 5x16 II 13x13
UP Replace Lift in
Same Location
7I I
4x10
11 4--
LL= -J -_1 LJ L_ _J
Existing Structures 3x1 i
r — Existing 5truc
"x13
N
�r--�r--JI
NT5
Scope of work:
Remove existing boat lift and replace in same
4x30 General maint_ on docking facility
I� II Electrical, plumbing, etc by other.

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