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Ii:AmA / ❑ DREDGE & FILL
2JENERAL PERMIT
*slew ❑Modification ❑Complete Reissue
❑ Partial Reissue
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f
A
❑Rules attached.
t Name—N (% 120 Ue0 Project Location: County N e l� Hakio� ,,
7�C '�h safll Street Address/ State Road/ Lot #(s)
/(/1i rIG`fDh State ZIP 2 Y% --
(lit ) �G/9---fQ8�—(' E-Mail Subdivision /!1-15-
ed Agent See t7' ',1O-A / 'f City im r//1""Oy.� , ZIP 15,
❑ lg'ECW /!
W 63PTA Rd- ❑ PTS Phone # ( ) / River Basin
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body /► *°4 nat i
❑ PWS: /� r
yes / ho' PNA yes / o ' Closest Maj. Wtr. Body �t1�` /
�J 7
ck) lengd
atform(s)
I/ Riprap length
distance offshore
x distance offshore
illdozing I
yes
e'
yes
no
e
ig permit may be required by: N 14 C�J 7-1 15 /11l l�97 4 ❑ See note on back regarding River Basin r
-ocal Planning jurisdiction)
NC Division of Coastal Mgt. Habitat Impact Computer Sh"t
a V / �✓�, Permit #:
Applicant: mil/
Date:
y
Describebelow 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.
FIN
(Applied for.
(Anti
DISTURB TYPE
Disturbance total
dis
Habitat Name
Choose One
includes any
anticipated
E)�
re
restoration or
an
temp impacts)
imp
Dredge ❑�Fffl�Both❑
Other ❑
S
Dredge ❑
Fill �f
Both ❑
Other ❑
(�N
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 ❑
Dredge ❑
Fill❑
Fill ❑
Both ❑
Both ❑
Other ❑
Other ❑
Dredge ❑
Dredge ❑
Dredge ❑
- . r-f
Fill ❑
Fill ❑
Fill ❑
-... r* 1
Both ❑
Both ❑
Both ❑
r�_ , M
Other ❑
Other ❑
Other ❑1
nfk.. r-1
.
L Sq. Ft.
TOTAL Feet
for.
rtntip Fri final
(Antici ated
Ipated final
(Applied
jrbanoe.
ud" any
Disturbance
total includes
disturbance.
Fxdudes any
bration
any anticipated
restorationand/or
_
/ortemp
restoration or
temp impact
Iarnount)
_temp impacts
amount
A4,
..`�►`
Un-
9,49W
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John 1
Governor DineCtor
AGENT AUTHORIZATION FORM
Date: 1f /13 / 1 (o
Name of Property Owner Applying for Permit: Name of Authorized ApeW for this proji
y R + �oS�n� n �� 0 �t t,�/�� SGoTr/�c/I?JJS B f� /%1#14p✓E
Owner's A/aNiq Address:
9 0 o Stev-L- e—
njL a-Ekly
Phone Number ( 910 ) -1 4 �. - 4 t S Y
Agent's Ata&Wg Address:
0AQ
•
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of apply
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property ioaaled at 9010 s} , s+�p� �-s I +u, w = I 'vc- a8Y ! Z
This ce 7*n is valid thru (date) CO 3 c I t G
I13
Property silprWWr* Dale
Name of Individual
Address of Property
DIVISION OF COASTAL MANAGEMENT
(Lot or Street #, Street or Road)
Lic')`bR, /0 C 8�i�
(City and County)
1 hereby ee tify 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 drawinj
the development they are proposing. A description or drawing, with dimensions, should
be provided with this letter.
1 have no objections ections to this proposal.
J P P
If you have objections to what is being proposed, please call Debbie Wilson with thi
Division of Coastal Management,127 Cardinal Drive Extension, Wilmington, NC
28405 or call 910-796-7215 within 10 days of the receipt of this notice. No response
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, moorings pilings, breakwater, boat house or boat lif
must be set back a minimum distance of 15' from my area of riparian access- unies
waived by me- (If you wish to waive the setback., you must initial the appropriate
7n,
? do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFIC_ ATION;'WAA ER FORM,
Name of Individual Applying For Permit: L)
Address of Property: �V?� I li YI
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that 1 own property adjacent to the above -referenced property. The
individual applying for this permit has described to me as shown on the attached drawin;
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 can Debbie Wilson with thi
Division of Coastal Management,127 Cardinal Drive Extension, Wilmington, NC
28405 or call 910-796-7215 within 10 days of the receipt of this notice. No response
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
1 understand that a pier, dock, moorings pilings, breakwater, boat bouse or boat Ud
must be set back a minimum distance of 15' from my area of riparian access- unles
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.
oil