67120D - Poe

�GAMA / ❑ DREDGE & FILL V I
'aeNERAL 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 `{ rr��
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /� 1)6 V
❑ Rules a ed.
t Name C)V\ Project Location: County
e _ I Street Address/ State Road/ Lot #(s)
State &C zi � � '+ � k/l
61�) a`; E-Mail Subdivision
ed Agent W ;1 � 14t V s(V) ity ' \ ZIP
❑ CW AEW IOTA p eS ❑ PTS Phdrie () J✓ River BasinN
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA AA
❑ PWS:
yes / no) PNA yes /{
Project/ Activity
AS �t
ck) length
ttform(s)
Platform(s)Ih -
ngth
nber
f/ Riprap length -
distance offshor
x distance offsh e
cannel
Ac yards
ip
se/ BoatJ
Adozing
G r,� 1
Lengt
not sure yes
um: n/a yes
yes
t,n -
attached: yes
ig permit may be required by:
-ocal Planning Jurisdiction) d% I l
Adl. Mr. Body nat r
Closest Maj. Wtr. Body
(Scale:/ - j
V1jZ 1 �� VVI ❑ See note on back regarding River Basin n
— it A 11

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: j,p-� . Permit #: G-71 10 - {�
Date: Q% 1
/� z ke
Describe below the HABITAT disturbances for the_. application._ All values shou[dmatch _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/ortemp .
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
a
laC-/
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 ❑

A 7A
�R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gmgson pee Freeman
Governor Diredx Secretary
AGENT AU7THOiZIZATION FQRM
Date:
Name of PropertL owner Applying for Permit: Name of Authorized Agent for this project:
Owwner's Mailing Address:
Phone Number a 3G) 67i
Agent's Mailing Address:
s!7
Phone Number f161,10 - 0.33'a
l certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
far and obtaining all CANNA PermAsp necessary to-�i-n-statf or construct the following (activity):
(
(my property located) at 221(r,
r
This certification is valid thru (date)
i
7)191
1
Pros ner Signature Date

DI'VISIOY OF COASTAL M4YAG KN T
ADJACEy-T RiPARLAN PROPERTY OWI IM STATXUWff
I hereby =- fy that I own. Propery adjacent to N tii, �i i
Property located at 711 (Nam4 of Property Owner)
on '(Lot; Rlock, Road, etc.)
(Waterbody) (T wn d/or Co
nnfy)
Applicant's phone # d - `� (- .j �� Malting Addr=,- i 7 -� �, , ., L
Hat-Mm has des=ffied to xe as aharwn below the devalopmemt halshe is pmposmig at that Iooatiun,
and I have no objections to the proposal.
DESCRIP'ITON AND/OR DRAWING OF PROPOSED DEVIMOPAM r:
an"Rapropaasiag development must. W is desuipffon below or attach a life drawhmg)
If you Nava objec oas to wbzt is beu; PraPose you mast notify the Division of Casstat
within 10 daps of receipt of this notice. Correspondence should be maned to L77 Cardinal e went (i}( in Wr
DCM iepresiatives can also be co�Dny
cted at [phone]. Wamington' b
NO M22=e is considered the samc as no ob-ecti— ify a have been natifzad by gtrood Mad
Simone
Pima or Type Name
Mailing Ad&=
-r-7-.6...... - Li 1 _ ", , -7
(Rfpanan Property Owner ixformfion)
1
Prim or Name
Mailing Address
--vC a Ga 2
State 1 70#-a39-79a3

-- r wwapM
DIVISION OF COASTAL I ANAGSmom
AWA C3W RVABAN noPERTY OAR 3TA.T 1?
Ihamby ova pmpmty g4aeft to Imo
P�IY Iroca�d�1Dq �'� rPn nru 'fit .�taaa�e Property Owner)
an A I v-,j
s (W� - _ N
x�amsae�aedto d�o�t►ph
bobw On d"obpaod asdlbmw obJoc�Cmoeiothepca�L b is at�ntboabit�q
D 'rION ANDIORDRAWJNG OF PROPOSED DB'YEIAPNDMT;
12kad&dPdeNOT°P�. j�� dio� brlow or a aside
T-ns W 1 N ew S x I tc 'Fi oc:�Nfn
ffymbwft to,.� tam vftbk-
xo orrempt a��t a t�nr "f Qot� m
DC'�'Leper =A abo bn eaoe sbOald ba aa8ed to Y3t7 car+imat Dims Batt Wig
- S���s b eo.od�ea eYe same as ao � if nan bem �d 1n Uertisea .�
sq�
p A -QrTxm Noma
e ► 11 1,
Am•o �►.�
Pfftor7hm Holia
3a3 5 &a rxeat Ave, d �53(Q
MM M A,ddnead
%�� A�1 1 I� � a$ C as

�� —- ----Existing Structures____
NT5
5copeofhlW:——__—_____
Install new 8x16 floating dock Owner:
Anthony Poe
2569 6regony Rd
Supply NC 25462