67126D - Pretasky

1CeAMA / ❑ DREDGE & FILL
i." NERAL PERMIT
New ❑Modification []Complete Reissue ❑Partial Reissue
d b th Stat f N rth C I' D art t f E t d Nat ral Resources
A B
Previous permit # 2a
Date previous permit issued
¢e y e e o o aro ina, ep men o nwronmen an u :oastal Resources Commission in an area of environmental co rn pursyant to I NCAC # 1 0
Name /L rs/�l jC�/! X; .���' LL Project Location: County 111�iVVM
dl✓1/
�63qnlei Sf. Street Address/ State Road/ Lot #(s)
State_ iZZIP�
(�) ' E-Mail - Subdivision / L
edAgent h/1i-� City Gj/%"INIsI�/��12 CZIP Z!
❑ CW II6w 5,frr .. Lms' ❑ Prs Phone # ( 2!` ��1 River Basin
❑OEA ❑HHF ❑IH ❑USA El N/A
❑ PWS:
yes /A PNA yes
Project/ Activity 4
:k)length
�tform(s)
Platform(s)
igth
nber
I/ Riprap length
distance offshor
K distance offish e
�h r,
annel s2 i jC
is yards
ip
;e/ Boatlift
illdozing
Adj. Mr. Body
Closest Maj. Wtr. Body a% l
Lengthnot sure yes 6o
um: n/a yes n
yes
i
stached: yes o
ig permit may be required by:
.ocal Planning Jurisdiction) V - - A -oq i / 11�
(Scale:
❑ See note on back regarding River Basin

NC Division of Coastal Mgt. Habitat IMpact CoIr> puter Sheet
Applicant: /� /�{f/� I�OIitC4 �'��s/ �L C Permit
Date: Imo{
}
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.
Exelu.des 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 ❑
Sob
2-54V
Dredge ❑ Fill oth ❑ Other ❑
S��jQ.
56)
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ .Fill ❑ Both [I 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 0 Other ❑
Dredge ❑ Fill 0 Both .171 Other El

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: ��6zn?!e /N��
Address of Property:
(Lot or Street #, Street or Road)
(City and County)
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, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat 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.)
Sign Name
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Date
Print Name Zoi �

0
PROPRM
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50'x50'x-70'
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MARITECH
INNOVATIVE SOLLITIONS FOR THE MARINE EN:
Disposal
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