68051D - Evans

4CAMA / DREDGE & FILL OiAv�rf C6 P1 l :'Q® -Al
a NERAL PERMIT VL1A�Z w ` Cr �A B
Previous permit #
New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources Z SbQ /b �.
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
I hd
t Name ✓1 '� Gf ✓�'h
2 15 JEIC"elx '4vt
rdr! �i�Q A (� State %CL ZIP qZ
" '323/E-Mail
ed Agent S 111A i Sti Uw
❑ CW Cd'EW BPTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes /!id PNA yes /
Project/ Activity
(" . 0-1" F
A) length Ix
Rform(s) Ilk
Platform(s)
igth
nber
I/ Riprap length_
distance offshore
K distance offshore
annel i
,ic yards
ip
;e/ Boatlift
{ r Ix«
u es attac e .
Project Location: County Al-GvV /
Street Address/ State Road/ Lot #(s)
she
Subdivision io
City ( Arat ,t , ZIP 7 gg41,
Phone # () � River Basin
Adj. Wtr. Body Nil h"A nat r
Closest Maj. Wtr. Body kil7e" Z, ryyK
iii� awl■■111191ME111102 aid
■■■■■r�I�f��J■■■�
ON
.■■�■■■■■■■■■■■■■■■■■N
42 /.a .
(Scale: — C
❑ See note on back regarding River Basin

,NC (Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: jpS� S Permit #:—
Date: Y112Iq C�t>a li�j
�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat 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/o
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
2
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 Q Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑

/1 1.21114
Date
Adjacent Property Owner
Z 13 EW % A.-
Mailing Addre
Cr rotira �-► N C 2 g`l'Z
City, State, Zip Code
Dear Adjacent Property:
Receipts for
Certified Mail
(Staple Here)
This letter is to inform you that I, TP�e1 have applied for a CAMA Minor
Property Owner
Permit on my property at Z i •F 116"y � o �4*`A C 4 , � in COUNTY VW u �a^�
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at (qA) 3ra -32'? f or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program, you may submit
them to
LPO NAME
LOCALGOVERNMENT
LOCAL GOVERNMENT ADDRESS
CITY, STATE, ZIP CODE
Sincerely,
- W—tA�
Property Owner
1711 M; d J)i �a1�S �►
AA..:I:.... A.JJ-......