67239D - Paschaloudis

,ICAMA / ❑ DREDGE & FILL L CO6 / f_
3"ENERAL PERMI
(New ❑Modification ❑Complete Reissue ❑Partial Reissue
.. A B
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources -7
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
t Name l( Y q t 0 Po{ sc kA l o o d I S Project Location: County ? n 8�
30 �`ci yyl Jru C t1;J�m l OO� Street Address/ State Road/ Lot #(s)
State Q( ZIP 2 R Q2.
2.,15'i E-Mail Subdivision
;edAgent44p� 4-�a�� 1MC1I(� �� j - arr+t f�cGar��r.��.�City c� r�� j aL�. ZIP 1H
❑ CWEW PTA ❑ ES ❑ PTS Phone # River Basin
( ) /�
❑ OEA ElEl❑ El IH UBA N/A Adj. Wtr. Body k5 `.t, hr� Nnat)/r
I] PWS:
yes / no PNA yes / no Closest Maj. Wtr. Body C �`AV`'c`(,
' Project/ Activity ... ; �:=�C ��on O Nu.-) X phA I't X I ar+ri X ZU r
ff
um;> (Scale:
ck) length (a' X
atform s -
Platform s X ZC
ier(s)
ngth
-nber
I/ Riprap length
distance offshore
x distance offshore
cannel
,ic yards
ip
se/f BBooadift Z x 1.
Aldozing
u * x IJ rarcl��
Length cas `
not sure yes no
um: n/a yes no
yes n
,ttached: yes no
ig permit may be required by: JPSci. < &aCko, ❑ See note on back regarding River Basin rt
-ocal Planning jurisdiction) .

NC Division of Coastal Mgt. Habitat Impact Comp
Applicant:
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
FINj
(Applied for.
(Anticipated final
(Applied for.
(Anti
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
distu
Excl
Habitat Name
Choose One
anticipated
restoration
any anticipated
rest(
restoration or
and/or temp
restoration or
teml
ternimpacts)
impact amount)
tem impacts)
amo
Dredge ❑ Fill ❑ Both El Other
`I `"1 Lq
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AN
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that 1 have authorized (agent) i _g,_—to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity)
at (my property located at)
_4�. I I H S&V-Ql 1"(Y, Dnn'p
I�I'bqcLch 14 aSQ45
This certification is valid thru (date)
Pronerty (honer 4iunatnre Flat"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBnOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to f �4 o u 5 (l a t o ✓d t 5 is
(Name of Property Owner)
property located at Z 6 tio r e-1 n e_ D r'
(Lot, Block, Road, etc.)
on 1 opxc�`1 y��� , in I ��xr 1 �� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: q1Q 36 7 2t Sri Mailing Address:
q ? G` 'a 1.0 C/ ,
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 me. (If you wish to waive the setback, you must initial the appropriate blank
below.))
Y 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
--------- -------------------------------------------------
(Riparian Prop e ner Information)
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATSOUSE)
I hereby certify that I own property adjacent to R-1n is
(Name of Property Owner)
property located at (-,I v (Z.
' (Lot, Block, Road, etc.)
on �Q,yI�CS C�1gV1(A ,in o?50id T—:�-__Gcck N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
Mailing Address:
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 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 PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riper' Pr r Information)
I r Signature

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