69166D - Gurkin

j CAMA / DREDGE & FILL
RENERAL PERMIT Previous permit# A B
IIOW Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources I
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
I,, El Rules attached.
t Name / � \�(y i l �'t(/��/�%i Project Location: Countyjn(�
�O 1 �� tOl lJ Street Address/ Statet Road/ Lot #(s)
t _ State �ZI P� `J 'D °1 �71�� iJ1N �J
(ACLA- -O Ati-MailVY1rh"VIit(WJ-(0&Subdivision
ed Agent City ZIP
❑)OV ❑ V ❑ WfA
❑ ES ❑ PTS
Phone # ( j ""—"—' --
River Basin
❑ OEA ❑ HHF ❑ IH
❑ USA ❑ N/A
Adj. Wtr. Body J Q7 �� n
❑ Pws.
LA/
yes / n PNA yes / nO
Closest Maj. Wtr. Body
' Project/ Activi
07TT P\ Ck A
j Oy
� (� 2V�✓1
a V (A
VI d
(Scale:
:k) length b 1 Y-70
,x
itform(s) Z (
._.
.
l
I
Platform(s)
er(s)
igth
nber
I/ Riprap length
distance offshore
x distance offshore
annel
'ic yards
ip
;e/ Boatl
Length
not sure yes
NNE■■����■���li��■fi1�r■1■r��iliill!/\.._

I
lU
N
m
>"s,
a�
QQ
O.-r,
P) Z V
❑ ❑
0
❑ ❑ Z
v\
r Z
Ei g� Ej O
E
y
_J
J_
C
rn > G
0
a
to
d)
•
Cr
2: Ui
w
o
• Q x
m
O
a) g
N O E
:fL T N {
O 'O p +0 CY
M U U
� -0
c' 'O E .t-' ca _
c Q Q
0) a) O O O ^
N U U C N
O rn
O O O w N
a 0 n
a >,
E C w «f O U C�
O V
Ua`tU)
L
Cl)_ Cco
CV
i)
CV
c')
to
Q
Q
C)
tataaaaa� 0)
m
ti
ru
ro
O
O
0
0
0
m
m
LP)
r-1
C3
lti
'AMA / I DREDGE & FILL
}
ENERAL PERMIT
1
Vew UModification UComplete Reissue UPardal Reissue
As authorized by the State of North Carolina, Department of Environment and Natural Resources
a
and the Coastal Resources Commission in an area of ondronmental concern pursuant
to I SA NCAC-
Applicant Name !� \t2� �71N%t�
Project Location:
(i
Address -1o( a fir,
StreetAddress/St
m
City _._`alnA State ZIP as�sc�_�
/_ Cam1
Phone # (�)_lY�S-w'' E-Mail 1mj1_/Vti+VI L. ;'(J -IONI Subdivisllvl
.N
Authorized Agent
Cky__(�
a�
E
PYCW �[W �&A DES OPTS
Phone # ( ^�
OAffC(e�
0
OOEA ❑HHF OIH OUBA DWA
Adj. Wtr. Bodyl
O PWS:
ORW. yes / RPNA yes / t�o
Closest Mal. Win I
1I
Type_ol Project/ Activity I .Or K1 rV A ■ VAAJ AfTA--_
IA.-+-t X f/l
M
tO
rn
0
0
0
0
CD
c-)
in
Z
a)
IL
0
N
T
3
DO
(Y)
E
O
LL
fn
n
But
a.
Bw
Bw
Sea
0
Shu
SA\
Mo,
ph.
Wai
I
I
Rim
Pon
A building permit maybe required by:
( Note Local Platningjudsdiction)
SCkyi
M or 4pucant t Names P—It s P
Sywwwe NPlea.eraWd phancesutmentmbsckofpertnitee Signature
,_ -00, 00 _.._ r'
Appk.".Fee(.) Cheek# �s.-.

NC 'Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: n t2 j Permit
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Found in your Habitat code sheet.
iabitat 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/or
temp impact
amount)
I
G L�
Dredge ❑ Fill ❑ Both ❑ Other
(Jd
�
00
O
Dredge ❑ Fill ❑ Both ❑ Other
5 (N
J Zv
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 [I Fill ❑ Both C] Other ❑
Dredge ❑ Fill ❑ Both 171 Other ❑

ADJACENT RIPARIAN PROPFRTY OWNER STATEMENT
i hereby certify that I own property adjacent to �- �iUel(�r lZ, i! 's
(Name of Property Owner)
property located at 2, i 1I, c(`,rti V,',U D t- _
%% '/ ��'' / (Addres , Lot, BlocklI, Road, etc.) n /` .
or, Lour. oo ho //7 /; . �v�_" In 5 n5� + 1 ia,�J� , (Jru ns�. �� CB. N.C.
(Waterbody) (City/Town and/or County)
The ap icant has described to me, as shown below, the development proposed at the above location.
I have no abjection to this proposal.
J have objections to this proposel.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing cdevetopment rnus fiIf in description below oraftach a site dtawrina)
see_
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 wash to waive
th s�tback, you must initial the appropriate blank below.)
I do wish to waive the.15' setback requirement.
v'
i do not wish to waive the 15' setback requirement.
(Property Owner Information) 4d'a Property Owner Information)
Sig -nature ure
Print or Type Name Print or Type Name
Mailing Address MVing Address

NC Division of Coastal Manageln
Cashier's Official Receipt
, M(z 6J 6v,,,Y)
Received From:
Permit No.: U I I QN
r v u
Applicant's Name: Map6 t(7vY ,-,i,•�
Project Address: j n 1 I �'^ `� `� � L �/�M r
Please retain receipt for your records as proof of payment
Signature of Agent or Applicant: -- --
Signature of Field Representative: