68033D - Gilmore

LAMA / DDREDGE & FILL I A B
"ENERAL PERMIT Previous permit #
Ke'w 7-Modification ❑Complete Reissue El 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 15A NCAC ules attached.
£' /
Name ���'19� �%A/C//7 ?� Project Location: County �2 t.,/ A7rk�
Street Ad/drJJesssJs/ State Road/ Lot #(s)
State Ve ZIP Z �7Cel
( 2Subdivision'2 77- E-Mail
ed Agent h e 6'City z'V1 s %rs / /, ZIP
17Cv1�A ❑ ES ❑ PTS Phone # (4�L'} S3k `���tiver Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Ad• Wtr Body et✓1 t`fs ��� r
❑ PWS:
yes no i PNA
' Project/ Activity
ck) len (a px 7G1
atform(s)
Platform(s) /
:ngth
amber
�d/ Riprap length
g distance offshc
ax distance offsh
hannel
mp_
use/
ne Length
not sure yes
no
f�
Closest Maj. Wtr. Body �%r a`.Ori !>i�D .SL
.
>rium: n/a yes �0 1 � -
yes �n
� I
Attached: yes
ling permit may be required by: V14 See note on back regarding River Basin

NC Division of Coastal Mgt., Habitat Impact ICOMP Ater ShOct
Applicant; vJ e 'J r
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.
L Feet
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq, Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp irn acts)
FINAL.
(Ant0lP
dislurl
F\ud
re$tD
am/0
im
W
Dredge ❑
Fill ❑
Both ❑
Other
C
Dredge ❑
Fill ❑
Both ❑
Other
S
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 ❑
r-f Fill 1"1 Rnfh n Other 0
Sq. Ft,
TOTAL Feet
for.
FiNA final
(Anticipated
ited final
(Applied
Dance.
Disturbance
disturbance. .
es any
total includes
Fxcludes any
and/or
ration _
any anticipated
restoration
temp impact
rtemp
restoration or

3ayment Proccessing Confirmation
Date Received F - 2/1/2017
;heck From (Name) Southeastern Coastal Construction Co
Name of Permit Holder Jane & Brian Gilmore
Vendor South State
Check Number 10173
Check amount $200.00
Multiple Permits No
Major/Minor
Permit Number/Comments GP 68033D
Receipt or Refund/Reallocated SSFF2634D

AW04
NC 04R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee Freeman
vedy Eaves Perdue ,lames H. Gregson Secretary
ivemor Dior
AGENT AUTHORIZATION FORM
Date: L-i _ff —
me of Property Owner Applying for Permit: Name of Authorized Agent forthisproject:
__/l�s��
cc<<_ J A- K&I�
vner's Mailing Address:
6d,1r?2 MC aZ Fy/ �
hone Number! ?�6)
Agent's Mailing Address:
�2
Phone Number (MO L S3 L f 7 3 2
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
k erg
,my property located) at C/o ('_' n ct-e-` e ( �
This certification is valid thru (date) - I Z' �f
97- / 7
m❑erty 0 SiqnatureDate

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 301x1_1W 11,& IEKalvl r�_11 U _ is
property located at
(dame of Property Owner)
� y� � � �� �cc�
(Lot, Block, Road, etc.)
on r��'(�%�L�7I �� , ink , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: %/0 -7 92 9 93 Mailing Address: y0 3 �u e✓ C
Gyi/",? /yC aFW
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
----------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in write
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
(Property Owner Information)
Signature I/ /
Brt cam„ C; I c4,k awe
Print or Type Name
(Riparian Property Owner Information)
Signature _
W 1<<ovk
5u tit V. - �v e. Ace- (Z Pv 0 e_d
Print or Type Name
Mailing Address
Mailing Address

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T fi uv7 61MC�`IL Jane¢ M///S 's
(Name of Property Owner)
property located at y(o U (o � t.��c I 2 ��
(Lot, Block, Load, etc.)
on Ne �J I (�Q 21 , in w 1 k7,�- o2 y-i O N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: �10 -79,2 99'3 y Mailing Address: 2103
NC ZB'f/-Z
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writii
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
(Property Owner Information)
tgnature
R r; u.i,, L i 1 m pq--E.
Print or Type Name
(Riparian Property Owner Information)
If
Signdture / J
�-��,�—� `vim
Print or Type Name
r�qoq
Mailing Address
Mailing Address

I
,% AW 11