68079D - Newton

CAMA / DREDGE & FILL ?p79 A B
hENERAL PERMIT Previous permit#
'New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina,.Qppartment of Environment and Natural Resources 4 '
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC T I ` !� ❑ Rules attached.
Name -V" a►n SU�^. )L` Project Location: County 1"..1'"nt�i✓� Z�"
C�(a lM01,0— f Street Address/ State Rosa LotL#(s)
State ZIPZ 5) � L, Z Z Af Its _` /, —e
(M) Ir E-Mail L Subdivision
edAgent l� ❑ t El0�1s�1-V(bDVN , /V`(�{� �7OV1 City jy05,c�- i tLCC �'1 ZIP ) �y
❑ CW EW PTA S *S Phone �S�) q o 6 ' "� y' '.Riiver Basin ✓�
ElOEA ElHHF ElIH VS
El N/A Adj. Wtr. Body �a (/!(/�( (nat /r
❑ PWS: A �% W —
,� � Closest Maj. Wtr. Body
yes /� PNA yes / /' I
Activity (k 1-n V---1
G-t tJ f1 S CA1N`t fk� .� En �� (Scale: l `
i
atform(s) _
Platform(s)
�ngth
amber
0 8/ Riprap length_
g distance offshore � (��
ax distance offshore_ _i
hannel /
ibic yards_
mp
use/ Boatlift
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,NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: iYA
Date:
Permit #:
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
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
Choose One 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
ternimpacts)amount
FINAL feet
(Anticipated final
disturbance.
Excludes any
restoration and/o.
temp impact
Dredge ❑ Fil! 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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis
Governor Director
Dee Freei
Secre
AGENT AUTHORIZATION FORM
Date:
11,11,1
lame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
iwner's Mailing Address:
�Zc Vu die-
�Y
hone Number (Tt I) —1
Agent's Mailing Address:
2798 Sea Vista Or.
ca STR
H5ioM Supply, NC 28462
UCT
Phone Number (qj 0) g8& — jj � �,j
;ertify 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):
A
e�
>r my property located at !J22 Cx't t�- �2 ,k iI C>- &AtcF-
I
lis certification is valid iIhru (date)
Property Owner Signature / Date

A*ORA
NCDEENR
North Carolina Department of Environment and Natural
Division of Coastal Management
Eaves Perdue Braxton C. Davis
for Director
AGENT AUTHORIZATION FORM
Date: ii)AaLz ty
f Propert Owner Applying for Permit:
k 4ls
Mailing Address:
Name of
Agent's Mailing Address:
1n r+ P U 1
Jumber (q A-) 9(ol " Lk 1 kA �Phone Number
that I have authorized the agent listed above to act on my behalf, for the pi
)btaining all CAMA Permits necessary to install or construct the following
property located at
r
tification is valid thru (date)
Property caner Signature Date
roes
Dee Freeman
Secretary
for this project:
q;I
of applying

I hereby certify that I own property adjacent to
(Name of P
F'v11 . a)
(Address, Lot, Block, Ro d
' Y , u w��T
on �' 1 in -
(Wate ody) (City/Town an
The applicant has described to me, as shown below, the development
locatio .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVE
(individual proposing development must fii► in description below or
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, be
must be set back a minimum distance of 15' from my area of riparian acc
me. (If you
wish to waive the setback, you must initial the appropriate bla+
:
do wish to waive the 15' setback requirement.�.r�
u or
I do not wish to waive the 15' setback requirement. X'
(Property Owner
nature 1,
ftu UP u.j i �_ L
int or Type Name
's
Owner)
N.C.
County)
goosed at the above
PMENT
ich a site drawing)
ithouse, lift, or groin
ss unless waived by
( below.)
Information)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to ✓49'yn E.5' /Ve4-,4173—
(Name of Property Owner)
property located at ��� �'/fi� ��ce- 4
/� (Address, Lot, Block, Road, etc.)
on
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below. the development proposed at the abm'
location.
v-' I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawinc
fitS'f2�--F ltie�J bq,(e"U.av�
WAIVER SECTION
i understand that a pier, dock, mooring pilings. boat ramp, breakwater, boathouse, lift. or groi
must be set back a minimum distance of 15' from my area of riparian access unless waived b
me. Of you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner lnt g=Uon)
Signature
Print or Type Name
�ing Addrelsi
(Adjacent Property Owner Information)
,S isjt�cr/ ure -� 7
�.. 7 z2j
Print ype Name
Mailing ,address