68001D - Fisher

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AMA / ❑ DREDGE & FILLI 8
001
7 "ENERAL PERMIT Previous permit# A B
New _ Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources l t,
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
EJ Rules a4ached.
it Name Project Location: County y wU v y
cliVLV, v w Street Address/ State Road/ Lot #(s)
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Eed Agent City { ZIP
❑CW *A ❑ES 5 Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body
❑ PWS:
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Local Planning lurisdiction) _ . i

NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: �1
Date:
Permit #: V
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
Ll 'I
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 0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to /7)qi V'k- -0 ` ri5Hk_' P 's
(Name of Property Owner)
property located at /%-' I VA f% e I
(Lot, Block, Road, etc.)
on C14 I-- 'i / k�ro( in 5 O �� Z-b", "e-1 �' , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: ql e1z egailing Address: / /Ir %Z l
He has described to me, as shown below, the development he 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 (l 5') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
ZI 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)
--------------------------------------------------------
(Riparian Property Owner Information)
Mailing Address
Signature

CERTIFIED MAID -RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGMENT
ADJACENT RIPARIAN PROPERTY OWNER NOT FE T O _ ANIWAIVER FORM
Name of Property Owner: « ��
Address of Property: e---1
(Lot or Street #, Street or Road, City & County) ^�
Agent's Name #:
Mailing Address;
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
have no objections to this proposal. I have objections to this proposal.
what
If you have in 10 days
to receipt
being proposed, you mustnotrfy the Division Of Coastal Management(DCM) in
westing within 1 p days of rece/pt of this notice. Correspondence should be mailed to 127 Cardinal Drive Eat,
Mlmington, NC, .28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no ob'ecdon if you have been nohffJed by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 you
wish to waive the setback, you mu3t initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
-_.__ LZI do not wish to waive the 15' setback requirement,
(Property Owner Information)
Signature
f 7I L`.1 17
Print or Type Name
Mailing Address
(Adjacent Pr perty QVvner Information)
Signature
Print or Type Name
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERlMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to P'q V'L -D , F-I5H-4- /Z 's
(Name of Property Owner)
property located at -01? P e& I v !!i'
(Lot, Block, Road, etc.)
on C4of (',ICE dl /y'�J.�C', in 5. O c-1"! iA �' /'t, '�
N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:_ �l ��l/_s% ��/dMailing Address:
vrit�olPT �v, c:
He has described to me, as shown below, the development he 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 access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
li 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
X,rf>�- C'll .�v
•-------------------------------------------------------
(Riparian Property Owner Information)
Signature
//„ . A l „ L

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWW NOTIFICATIG
Name of Property Owner.
Address of Property: //g/ v i i ' y,;` / C% ,�f—f
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
VER FORM
1 hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
_have no objections to this proposal. i have objections to this s proposal.
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 127 Cardinal Drive Ext,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no ob'ecdon if-j2u have been nottfiedby Certffled Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 you
wish to waive the setback, you must initial the appropriate blank below.)
t-do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement,
(Property Owner information)
Signature
i7 =/r//C x.
Pnnt or Type Name
Mailing Address
(Adjacent Property Owner Information)
/C
Signature
Print or Type Name
ailing Address

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