69049D - Morris

�QAMA / XDREDGE & FILL
3ENE�MRALon PERM❑pITSSUe
❑ Partial Reissue
N° 69049 A B
Previous permit #
Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC G T t V
❑ Rules attached.
1t Name Project Location: County_ �L. M ci j 6V
Street Address/ State Road/ Lot #(s) [✓�
(1low VA to State ZIP
t () E-Mail Subdivision
:ed Agent ��r� C�YI YIGt.1�UGt�i1� City +/1/1ZIP Lt
❑ Cw ❑ EW ❑ PTA VS PTS ��'Phone # ( )rl River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
❑ PWS: i
es / no PNA yes / no Closest Maj. Wtr. Body \
F Project/ Activity alA I Y L fug V. I j I j auoy J�
ck) length
ngth
tuber
prap length-
distance offshore�T_
x distance offshore L�
cannel
Length t/— I U V
not sure yes �p
um: n/a yes ltss''
yes
ttached: yes A.
SIR
6.62'
S/R
i
i
i
EAVES
(Scale: i 11_ A
��1�V� `^' S�►� S ,3?•43'47"YV 3�•03� „��,S�37'10�46"W
v� "W 24.93
S 2� to
5 20�g2'W' • NORMAL HIGH WATER LINE
N2958'29"-
>:"''-
11.75' 0\
S 56.4749" W F'
S 4946'33" W 4 _ N 35' 1733_E
— 41.40' — — -
0.62 COASTAL WETLAND LIN jrj
—0.60, i I
I �
SHADED ZONE
ig permit may be required by: � / I�L� �,1 fN�P� (a( ❑ See note on back regarding River Basin rw
.ocal Planning jurisdiction)

--r--"---- I \-------�
Comments
3/29/2017
Chris
Connaway/Connaway
Marine Construction
Kenny J. Morris PNC Bank 1262 $400.00 GP 69049d

NC Division of Coastal Mot, Habitat Impact COMP Ater ShOe-t
Applicant: .O LVI "w
v►�i � Permit #:
Date:
Describe -below the HABITAT disturbances for the application.
foundin your Habitat code sheet.
All values should match the name, and units of measurement
Habitat Name
a
DISTURB TYPE
Choose One
TOTAL Sq. Ft,
(Applied for.
Disturbance total
includes any .
anticipated
restoration or
temp impacts)
FINAL.
(Antidp.
dia
Facd
rests
andb
im
Dredge [I
Fill [I
Both [I
Other
G v
Dredge ❑
Fill F1
Both ❑
Other El
Dredge ❑
Fill ❑
Both ❑
Other El
Dredge ❑
Fill n
Both [7
Other [IDredge
❑
Fill ❑
Both El
Other ❑
Dredge 1-1
Fill ❑
Both ❑
Other El
Dredge El
Fill El
Both ❑
Other El
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge El
Dredge ElFill
Fill ❑
❑
Both [I
Both El
Other El
Other El
Dredge ❑ Fill [I Both ❑ Other ❑
Dredge ❑ Fill ❑ Both El Other ❑
Dredge El Fill El Both ❑ Other 0
Dredge El Fill El Both ❑ Other [IDredge ❑ Fill ❑ Both ❑ Other El
Sq. Ft.
urbance.
odes
TOTAL Feet
for.
FINAL rer�
(Anticipated final
orted final
(Applied
Disturbance
disturbance.
any
total includes
Excludes any
and/or
ration _
any.anticipated
restoration
temp impact
rtemp
restoration or
rnnunn
temp impacts)_
amoun

N.C. D1V1SiON OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
, , l / / •- f^ 13 Ali --P-1
I certify that I have authorized (agent) rX.6 ca--JW O oJo p to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) L /-x4,Iel
at (my property located at) 3,1/0 166/1 4j . ',(/,/ Yg�0/7—
This certification is valid thru (date) Z' 14 'l8
Property
,2-) � -- Z--e,-i-?
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t,Jnlr' Uiy`, S J ;- s
/ (Name of Property Owner)
property located at ' ( viz t4l) L"1¢L 12',�
0
(Address, Lolgck, RAaq, etc.)
on-rcWut) in 6A ,s�` r i�✓/1�1.✓ddt� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to do /
Y I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement. n
(Property Owner Information)
r J
Si joature
'/'iri.
Print or Type Name
(Adjacent Property Owner Information)
Siena re*
Print or yp le/Nme

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 2, le""Sr. 's
(Name of Property Owner)
property located at `1�S _%F'� /� G.�cy / ,��,.,�
(Address, Lot, Bloc ,Road, etc.)
on �GG�I lti) , in /✓.►..�oui (,�f.'�� . , N.C.
(Waterbody) (City/town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
—Ad4-4/ 1 have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
4 //1 U A /e,J 6 Propu4- hJ t 4 rit,�Jsf t .�f�4�,li
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Stgnatu
%[ - /� �L /'rr
Print or Type Name
Signature*
J=. M W )3-) T-r. , A ✓'
Print or Type Name
1 0 1 L7 4 -_. W� - _ ,

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