67194D - Hall

LAMA / ❑ DREDGE & FILL, 1_ cot 671)4 A B
iEN ERAL PERMIT Z- S-��Ci 10 Previous permit #
New [-]Modification ❑Complete Reissue ❑Partial Reissue `L� 16 Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources .-� �f �%
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f� (/ ► Rules� h
.xr#—�
tA4--' Project Location: County
61"14 / jam'^ ,/V` 7'
Street Address/ State Road/ Lot #(s)
State
ZIP GiW}
--fir
" `
Subdivisions �/ ,` v /,zt►ii
E-Mail
Al/ �"'P�^ �f
��oo
City ZIP G
ed Agent
0
❑ CVN
EW ETA El ES
ElHHF
❑ PTS
Phone # ( - fiver Basin
❑ OEA
❑ IH ❑ USA
❑ N/A
Adj. Wtr. Body ✓ � tt)
❑ PWS:
_/ v
Closest Maj. Wtr. Body
yes �`"no;
/
PNA yes F_tta�
Project/ Activity
L
ck) length X�
atform(s) R" S
Platform(s�
,ier(s)
tuber
.d/ Riprap length
g distance offshore
distance offshore
han'hfI
ibic yards ! j,
mp
use/ Boatlift
3ulldozing
r
ne Length %.
)rium: n/a yes no
ye:
Attached: yes
Jing permit may be required by:
Local Planning Jurisdiction)
❑ See note on back regarding River Basin

NC Division of Coastal :Mqt. Habitat fropact' C.MPUter Sheet
Applicant:
Date:
Describe (below the HABITAT disturbances for the application.
All values should snatch the name,.and units of measurement found in your Habitat code sheet.
TOTAL Sq: Ft. FIRIAL Sq. Ft. TOTAL Feet FII
(Applied for. (Anticipated final (Applied for. (Ar
DISTURB TYPE D'tsturbance.total disturbance. Disturbance As,
includes any Excludes any total includes. Ex,
Habitat Name Choose One anticipated restoration any anticipated res
restoration or and/or temp restoration or ter
ternimpacts) impact amount) temp irti acts arr
W .
Dredge ❑ Fill ❑ Both ❑ Ot OeL
Dredge ❑ Fill ❑ Both. ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Botts ❑ Other ❑
Dredge. ❑. Fill ❑ Both ❑ Other ❑
i;..:: Dredge ❑ Fill ❑ Both ❑ Other ❑'

Pat McCrory
Governor
ate
North Carol na Department o` vironmen and Natural Resources
Division of Co tal Manage ent
Braxton C. Davis
�pplicantName _ /�,11 S4
flailing Address _ 1 Zo N
SwF
1. certify that I have authorized (,
purpose of applying for +and obt
10 W;M.03L , C-1,
r�kk-q S-O --A
all CAMA
This certification is valid thru ( ate)
Signature
c t_L
John E. Skvarla,
Secreta
C r. \ \ L to act on my behalf, for the
t.5 necessa to install of wn.strua (activity)
't (location)
N%

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to r' ia� S a`ds� r S,lu �% --s , L-L's
(Name of Property Owner)
property located at %I 0 i� ll���l� G��� S,^ens , 1 c
(Address, Lot, block, Road, etc.)
on , in �.� N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: M�IU�:�I Mailing Address: 1 ZO N Sl �!
Agent's phone #: '710 - A-1 - b;-lSz, C112, , N C ZZLI lS
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.
-----------------------------------------------------------------------------------------------
DESCRIPTIOH AND/OR DRAWING OF PROPOSED DE`✓ELOP""ENT
(Individual proposing development must fill in description below or attach a site drawing)
c 0\
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. Contact information for DCM offices is
available at 1: or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
Signatur
1J,, I 1
Print or Type Name
Mailing Address
r)c. ZYKh5
City/State/Zip
(Riparlan Property Owner Information)
Signature
Print or Type Name
One jJ ; I q r .4 C : ,-C I-t
Mailing Address
Ci4y0ate/Zip
n. . .-. - _, ..

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to A i 1 Sk��Jr �,` Soh^ h � , l CC 's
(Name of Property Owner)
property located at _71 n W J ASN 3 L. C''c,(-(-
(Address, Lot, Block, Road, etc.)
on in ��.1 N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: pi Mca1- I I Mailing Address: i Zo
Agent's phone#: AIL' - 38`i - G�SZ. S.,11 1� . /4c. ZaLiLS-
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 DEVELOP 10ENT
(individual proposing development must fill in description below or attach a site drawing)
l
e-
►f you have objections to what is being proposed, you must notify the Division of Coastal agement
(DCM) in writing within 10 days of receipt of this notice Contact into or DCM offices is
availableatY�'if:ilv✓vfw.nccc��v _:::y �_�_; .3c .i �.: w orbycalling 1-888-4RCOAST.
No response is considered the same as no ob'ection " Y u have been notified b Certified Mail.
(Property Owner Information)
Signatu
Print or ype Name
170 N. -�L,4rg
Mailing Address
City/State2ip
(Riparia Pro erty O per Info at on)
Sig ature
Print or Type Name
i b
Mailing Address
Ci6/State2ip
/ I n, 1 6 11 Jr -

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