66554D - Varnedoe

01
1CAMA / ❑ DREDGE & FILL
aENERAL PERMIT S Previous permit #
A B
!New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
t NameQJrf Q , C?i�� Uy ��y �Y �'� �(� Q_ Project Location: County vv, ' ,�-
�' fVitt Street Address/ State Road/ Lot #(s)
State �tiv ZIP i
ice) j -Mail _ Subdivision
edAgent City �C`i�✓� CA �^ ZIP—' zL-
❑ CW EW �IfTA ❑ ES ❑ PTS Phone+# (0) (a - 03�5- River Basin OW
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body CO. viol
ElPWS: 1 y ,� '1 nat
((��-' , ( n Closest Maj. Wtr. BodyV Vy
yes /(n % PNA yes / Co) 1/ D �A
Project/ Activity
rkoo
:k) length
Rform(s)
Platform(s)
igth
nber
I/ Riprap
offshore
offshore
Ac yards_
ip
W Boatlift
_'.- -
Length o
not sure yes no
um: n/a yes n
yes o
stached: yes no -
ig permit may be required by: �� W dl ((,((
_ocal Planning jurisdiction)
fm iy�
❑ See note on back regarding River Basin
- I I „,lei a R. , l � e I' i n

NC Division of Coastal Mgt. Habitat Impact Com
Applicant. S 1 U ` VvV��"� U�� �4
Date. ©� /(}� / ' O
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
FII
(Applied for.
(Anticipated final
(Applied for.
(At
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex
anticipated
restoration
any anticipated
re:
restoration or
and/or temp
restoration or
ter
temp impacts)
imI act amount)
tem im acts
arc
l/ll
Dredge Fill Both Other
El
t
1 o
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Division of Coastal Management
.Beverly Eaves Perdue ,lames H. Gregson Dee Freeman
Governor Director Sem!ary
AGENT AUTHORIZATION FORM
Date. I d t Jr/ 4
Name of Property Owner Applying for Permit: Named of/A/uthoeltead Agent for this protect
Owner's Mailing Address:
f
Phone Number a /l '3 0 _ / !`�=2
Agent's Mailing Address:
may) c'``rE'_r:• C r" a `� �� � G��� _
Phone Number 8I6
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and oTaining ail LAMA Permitsnecessary to install or construct the following (activity):
(my property located) at _1 Crr ?-IV
This m4i fmation is valid thru (date) 5L%%
Property Owner Signature
177 Cardinal Unie Ext, W+irmgw, NC agM One
c» ,.n�f�7oR.�9tRc!'gx q ��QS3f�Ete �nwrnet wwvrncaaasce4rnanagen+a�l.rre+ NorffiCaro l'
'A s..,... ..

I
II II
II 10X16 floating dock II
UP
ninum ramp Existing Structure II
II II
I� r
J
14'
122 Greensboro St

% I
Prop" located at __ :_0 -�d
.(Lot, Block, Road, etc,)
On
N.C.
(Waterbody) (Town and/or Comity)
Applicant's phone*19 4301M%g Address--- %I
d7
He has descrUied to me, as shown below, the development he is proposing at that location, and, I
have no objections to his pruposal. 1 understand that a pier/mooring pilings I boatlift / boathouse
nmst be set back a minimum distance of fifteen feet (151 from my area of riparian access untess
waived by me. (H YV-Q Whh to waive the setback you must initifil the appropriate GIL k
below.)
I do oat wish to waive
do wish to waive that setback reqllire me-nt-
DFSC7R'MON A-ND/OR DRAWING OF PROPOSED DEVELOPMENT-
(TabejWedin hyindividual proposMgdevelopmenp
(Information for Property Owner Applying (Riparian Property Owner InformatjoxL)
for
Mailing Ad&rw
city t�te� P
ne Number
A,
Signature Date
Signature
Print 037 Type Name
Telephone Number
Date

o;�'c
ADJACENT RIPARIAN PROPERTY OWNER STA1718ONT
(FORA PIBR400RING PLUNGSBOATL7MOATSOUS'E)
I hereby certify that I ownproperty adjacent to :6'•VtTe J �A r ne 's
(Maine of Property Owner)
property located at /':aA
j (I.ot, Block, Road, etc.) -�
on CO1�" lz . in
(Waterbody) (Town and/or County)
Applicant's phone # 19 — %3U l� kx mg Address: / ��►^ e
Ile has described to me, as shown below, the development ba is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15� from my area of riparian accesssiimless
waived by me. (If you wish to waive the setback, you must initial the appropriate black
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
cityftw1p
ne umber ,
Date
(Riparian Property Owner Information)
Signature
Larry Reinhart
Print or Type Narce
910-612-6890
Telephone Number
4/20/16
Date