63207D - Painley

NdAMA / ' ,DREDGE & FILL
3ENERAL PERMIT
New -Modification []Complete Reissue
. � L",-,- 1 I// V / (
❑Partial Reissue
Previous permit #
Date previous permit issued
V
rized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
( �/�.�(❑ Ru
tles attachj
It Name ti�-Y1 Project Location: County I ✓ kc --
U� V } Street Address/ State Road/ Lot #(s)
It \f ( StateV A- ZIP Off" [
1�b Fax # O Subdivi ion
:ed Ner t """""'
❑ CW El PTA ElES ❑ PTS
YoEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes / o PNA yes ff no Crit.Hab. yes / no
F Project/ Activity
ck) length
1(s)�- -
ngth
mber
d/ Riprap length
distance offshc
uc distance off
sh
cannel 2
bic yards
np
ise/ Bo lift
ulldozing
Y-
e Lengthy.
not sure yes
s: not sure yes n
ium: n/a yes n
yes n
kttached: yes n
ng permit may be requirec
q.
Citykk / ZIP—M —U
Phone # ( ) River Basin
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale: I �L- 4

NC Division of Coastal Mgt. Habitat Impact Computer ;sheet
Applicant: �Q 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.
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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
1
V
NDD
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 [I
Dredge [] Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [I Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROP RTY O ER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property: 3W-�- AJ &c C,4 a U
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http:/lwww.nccoastalmanagement net/weblcmistaff listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
print or Type Name
2R) /6,
nailing Address
(Riparian Property Owner Information)
Pignature
l e/ f'
Print or Type Name
_7922 2 C71S-1^7 1// Lti
Mailinir d,1,4, o

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Nddress of Property: 392� l�l,� �jeCcc�
(Lot or Street #, Street or Road, City & County)
%gent's Name #:
kgent's phone #:
Mailing Address:
hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
hey are proposing. A description or drawing, with dimensions, must 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
DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
vailable athttp://www.nccoastalmana_qement.netlweb/cm/staff-listing orby calling 1-888-4RCOAST.
to response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
e set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
Du 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.
T=Z
f
gn ture 0 1
int or Type Name
r,
3ilina Address
(Riparian Property Owner Information)
nature
Print or Type Name
Mailinq Address