66575D - Widby

7 CAMA / ElDREDGE & FILL K L, G/6-/
lD y A B
"'ENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources t j\O1
-oastal Resources Commission in an ea of environmental concern pursuant to 15A NCAC r V
❑ Rules attached.
it Name Jt Project Location: County &KWOK ►{ k
: t Y Street Address/ State Road/ Lot #(s)
Statel ZIPD
` n_ ail Subdivision d''t Y LZA:ed Agent City •�%� ZIPElCWA [-IES❑ PTS Phone # (� River Basin i
❑ OEA ❑ HHF ❑ N ❑ URA ❑ N/A Lieu N I ►A i
❑PWS: �1V�1�
yes /� PNA yes
f Project/ Activity
ck) length
atform(s)
Platform(s)
,ier(s)
ngth
mber
d/ Riprap length
distance offshc
uc distance offish
cannel
Mc yards
�' e Length + �
not sure yes no
ium: n/a yes n
yes no
kttached: yes no
ng permit may be required by:
Local Planning jurisdiction)
Adj. Wtr. Body
Closest Maj. Wtr. Body..--.
ody f L1� V Yy
(Scale: 11
10
❑ See note on back regarding River Basin n

NC Vivlsion of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Permit #: U u t�;1 6
Date:
UL i( �j
l
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
-labitat 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 fina
disturbance.
Excludes any
restoration andA
temp impact
amount)
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 ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

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2/07Z2004 19.20 9109429806 GREG HOLDEN PAGE 01
DIVISION QF CQASTAL M NAGEMFM
AD�?►CFKT RIFARA2�x PROPERTY QWNER NOTIFICATIQW/WA-TVE&_ FORM
. Nam* Of Individual Applying For Pez-m'it
6
Address -of Property:
(Lot'or street or Road, C ty & County)
I hereby certify that I mm- property adjacent to- the above -
referenced property. This indi_vidual applying for this permit has
dsscribftd to we as shown an the attachad drawing the davelop ent
they are proposing. A description or drawing, rith dimensions,
should be provided with this letter.
/I have no objections to this proposal.
I understand that a pier, dock, mooring pilings, breakwater, boat
houses, lilt _ must be sat back a minims distance of 15'
from my area of riparian access unless waived by me. :(If you wish
to waive the setback, you laust initial the appropriate blank
below.)
1-do wish to waive the 151'sotback requirement_
I do not wish to waive the 15'setback requirement.
W'. ,d /�✓fi/��i ,/
1 lM MUM, /51

2/07/,2004 19:20 9108429806 GREG HOLDEN PAGE 01
DIVISION OF COASTAIHHMAGE _-
ADJUIRM IMMIM PROPERTY OWHER NQIFICATI W/3M=1CRM FORM
ZT
.Name of individual ApT plying ing For Permit ',
Address -or Property:
(Lot 'or 5trest , tract or Road, City & County)
I hereby certify that I own- property adjacent to the above-
raferenced property. The individual applying for this perait has
described to me as shown on the attached drawing the developaent
they are proposing. A description or drawing, rith dimensions,
should be provided with this letter.
I have no objections to this proposal.
I understand that a pier, dock, mooring pilings, braakwater, boat
hansa, lift _ aunt be set back a xiniw= distance of 15,
from my area of riparian access unless waived by an. :(If you wish
to naive the setback, you initial the appropriate blank
below.)
I.:do wish to waive the 15fsetback requirement_
I dQ not wish to waive the 15'setbeck requirement.
i'
r DataT FVA
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