66526D - Ramish

CAMA / ❑ DREDGE & FILL
11311( A B
GENERAL PERMIT l0 1� Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
e
zed by the State of North Carolina, Department of Environment and Natural Resources t
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC • i
❑ Rules attachgd.
Name l \U ktNLM"\ Project Location: County
1AZI
1q.LeA State kL ZIP
11�1) ��' -Mail n'lYlltiYl��1�'`���'_.r`I(•CUVi"s
!d Agent
❑ CWEW A ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
,es eono' PNA Yes / no
Project/ Activity
Length }
notsure yes A
im: n/a yesyeses`
Street Address/ State Road/ Lot #(s)
I , i c
Subdivision
City £ ` ' ,v i ZIPXW
Phone # ( ) River Basin C''4
Adj. Wtr. Body "IX' -`I nat
Closest Maj. Wtr. Body
(Scale: 1 �,
g permit may befMquired by:
.ocal Planning Jurisdiction)_.-..)
❑ See note on back regarding River Basin ru

4C Division of Coastal Mgt. Habitat Impact Computer Sheet
applicant: mvj V�4\ Permit #.
late:
,escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet.
abitat 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/oi
temp impact
amount)
owDredge
❑ 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 0 Other ❑
Dredge ❑ Fill ❑ Both 171 Other ❑

P.
I hereby certify that I own property adjacent to ! ' ` c5 e
property located at Oe
on /''ram
(Wate
J�Ji C L f `"1 i G
(Name of Property Owner)
's
'ess, Lot Block, Road,
-n 71
N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If y 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.
(Prope_rty Owner I ormation) (Adjacent Property Owne Information)
Sign e
S Ur
Print or Type Naff
r e Name
-7 6 n (' ��2 . j�ip
Mailing ,address� !/ a..,)y�e�e,�s
X j',*7 1: - L . ,> Al f Mogp Address, Sri,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to + . ` os € J "1-J'J i C G 's
j (Name of Property Owner)
property located at
- I c. e 67,
_s
ddress, Lot Block, Road, 0A.)
on f�,r%h `4; cW�j5- 0/, �' ° � r ` in � ��r-� 1 �i0�/ � �-J� N .C.
(Waterb y) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iocati
f have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
1 /1�-
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
Zme.If ou wish to waive the setback, you must initial the appropriate blank below.)
sh to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Propqrty Owner Information)
1114,
j
Sign e r l
Print or Type Na
Mailing Address
(Adjacent Property Owner Information)
Si _ture'`
tlt,l'n.i f%�ms
Print or Type Name
Malting Address

DEEF
RAMIEH DOCK 147 OCEANGREENS
RAMIEH DOCK 147 OCEANGREENS
ER

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VIL.
li147 Oceangreens Ln