66671D - Schad

ICAMA / ❑ DREDGE & FILL L -
3"ENERAL PERMIT i
2iaReissue
J Previous permit #
fNew []Modification❑Complete Reissue ❑Pa
Date previous permit issued
Ized by the State of North Carolina, Department of Environment and Natural Resources 0-1 �� ' l 0
h
:oastal Resources Commission in an area of environmental concern
pursuant to 15A NCAC
t Name ('� � SC �n A
❑ Rules attached.
Project Location: County 6".Sa H ( K
Street Address/ State Road/ Lot #(s)
J lk W State f,\JJ ZIP
(709 ) � 5(0 E-Mail
Subdivision ---�""
`
edAgent ()k/,\\ A-(�1a(8S6Y\ t wt M rAUN
City kACA c,(/1 ZIP $��P
ElkE CW IW p PTA ❑ ES ElPTS
(`, bt r7
Phone # (AID ) 5 0- 0 33 5 River Basin LV �
❑ OEA ❑ HHF /❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /I
❑ PWS:
yes / no , PNA yes / no
Closest Maj. Wtr. Body w V V
'Project/ Activity
0n((-vv{t C1
x ; , - r , t,V O 0\' -t' , �� ll Vj " � (Scale: 1
:k) length /
►tform(s) Sl
!
r�
Lt ✓1 ti 7`
— i '
Platform(s)
3
13l
fL
ngth
nber
f/ Riprap length__
distance offshdre
x distance shore
,an
yards
ip
Length �. 5
I
not sure yes
cum: n/a yes
yes
ltached: yes -
ig permit maybe required by: b (I`'Vt O+ 1 V, (ti ❑ See note on back regarding River Basin rt
-ocal Planning jurisdiction),
- k, 11 - I% 1 11

NC, Division of Coastal. Mgt. Habitat i;r Paot Computer Sheet
Applicant: Permit #: (� (� G. -
Date: 4 Gt `t
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
FINAL Feet
(Applied. for.
An final
(Applied for..
(Anticipated final
Habitat Name
DISTURB
TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes -any
total includes
Excludes any
anticipated
restoeation
any anticipated
restoration and/oi
restoration or
and/or temp .
restoration or
temp impact
temp impacts)
impact amount)
temp impacts.)
amount)
Dredge ❑
Fill ❑
Both ❑ OJEDI
13C l
C
4Dredge ❑
Fill [I
Both ❑ O
Dredge ❑
Fill ❑
Both ❑ Other ❑
Dredge, ❑
Fill ❑
Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gmgson
Governor Director
Dee Freen
Secret
AGENT AUTHORIZATION FORM
Date: (c — c� 1 _ 1
Jame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
__W I I I R 11 cl.,��. is
hvner's Mailing Address:
I4
�kl1�w. AL�R173
Agent's Mailing Addresses r�
"hone Number (7G I F `� �,. i�� Phone Number r (-,))
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits n ssary to install or construct the following (activity):
J LL I�
;my property located) at I ,� S
This certification is valid thru (date) / (c
Prnnprty Owner Sin nfnra flnfn

CERTUD MAIL-RETi RECEIPT REQL-ESTED
DIVISION OF COAST.AIL IYLAr�iAGElYIENT
ADJACENT RIPARLkN PROPERTY OWLNER STATEIMMNT
I hereby certify
property located at
that I o-�vn property adjacent to _
�j `a ` �, 1, .. <
l �: c
rt �j c coo` 's
—���
ame of Prop f Owner)
n ,
(Loll Block, Road, etc.)
on c: c in
(Waterbody) (Town and/or Coun )
Applicant's phone #: 7 C''— t - 9p` — �?� `� Iviailing Address:
Q��/lc
r
1�
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
[MS]
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
T(Individual prroposing development muss fdl in description below or attach a site drawing
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing
within 10 days of receipt of this notice. Correspondence should be mailed to 117 Cardinal Drive Ext Wilmington, NC
DCM representatives can also be contacted at [phone],
(Property Owner Information) jj
Signature
—W I I `Z �C\CA
Print or Type Name
Mailing Address
Q-
C,t„ i . r�tP i ,,,
P
Print or Type Name
Mailing Address

.•..--, �1R.hN,cad
CERTIFIED MAIL —RETURN RECEIPT REOL MD
DIVISION OF COASTAL TAL MA_iAGEM r4T
ADJACENT RiPARLAN PROPERTY OWiYFR STATEMENT
I hereby certify that I own property adjacent to _ ' ca S , c 's
TTn�p located
a t 1 c tit Pam of Prop Owner)
Owner)
property locate at 3 `� SCL�� 4 C'7 L� r.. \� \ V Li C n rl+- L n M 1
..rBlock
tt,
(Waterbody)
4plieant's phone #: % 0q - 92<4 — S
etc.)
N.C.
(Town and/or Conn )
Making ddress: 4 rn ��
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individualproposing development must fia in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in w itin
within 10 days of receipt of this notice. Correspondence should be mailed to 12_7 Cardinal Drive Ext YPiimington, NC
DCM representatives can also be contacted at [phone]_
No response is considered the same as no obiaciton if you have been notified by Certified Matt
(Property Owner Information) _
Signature
U]' 1 1'Z i,CLIZ,, tiS[X1
Print or Type Name 1
�3a3 of as 1' QJ
Mailing Address
,-"(Riparian Property Qwner Information)
Signature
1
Print or Type Name
Muling Address

CANAL
II Iill II
11 IN Existing Boat Lift II IN
II Propoaed boat Ilk II
14ftx14R II_ illl II
=9 II II
it Proposed bfbQ2R flnger pier If II
LL_______=_====�i II
II II
II II
II it
6det1ng Structums II II
Il II
II II
II II
I 11 3"
--------------------------------------
Scope of work:
Installation of 13Rx13R post lift on north side of property
Installation of access pier for existing lift
Jack Potter
131 Salisbury 5t
ra+•
K111am W Grey Jr.
154 Salisbury 5t
across the street