65117D - Parker

CAMA / ❑ DREDGE & FILL ` t�
;ENERAL PERMIT
INew Modification ❑Complete Reissue CPartial Reissue
Previous permit # t
Date previous permit issued
65
•ized by the State of North Carolina, Department of Environment and Natural Kesources , �) �I sr
V
Resources CommRsion in an area of environmental concern pursuant
to 15A NCAC 1
t Name � �' i C - V' C,
Rules attached.
Project Location: County ��� 'r"OU,
L
Street Address/ State Road/ Lot #(s)
State
ZI��►ram-'--
}�'' yC`--; Fax# ()
Subdivision
ad Agent
VO-Yv J'fJk �" f r`1 �4
City Z_"IU / + ZIP -{
CW q EW ] PTA �, ES ❑ PTS
Phone # / o ��`' G' 1 `-•�'+ River Basin tY: F
l�)
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
Adj. Wtr. Body., ,_ a r� cu �>. �- nat
yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body '•� ? ' �'�'`
Project/ Activity
:k) length
(s)
er(s)
igth
nber +
I/ Riprap length
distance offshore
( distance offshore_
annel
X yards
•
,p
;e/ Boaifi
illdozing %
Length
F
not sure
yes
nj '
not sure
yes
n
im: n/a
yes
n
yes
no)
ttached:
yes
no
Is'\ S71/i/I
AIT5
g permit may be required by: El See note on back regarding River Basin n

NC Division of Goastat .Mgt. Habitat impact- G6.misuter sheet
Applicant: •
Date: 2--
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in. your Habitat code sheet.
TOTAL Sq. Ft.
FIMAL Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
Disturbance
(Ai
die
DISTURB TYPE
Disturbance.total
includes any
disturbance.
Excludes any
total includes.
Ex
Habitat Flame
Choose One
anticipated
restoration
any anticipated
re;
restoration or
and/ortemp
im act amount
restoration or
tem ifb acts
ter
arr
tem im acts
0
Dredge ❑ Fill ❑ Both ❑ Other
(�
Dredge ❑ Nil © . o .
Dredge ❑ Fill ❑ : Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑. Fill ❑ Both ❑ Other, ❑
Dredge ❑ Fill ❑ Both ❑ Other
f4

comments
Lighthouse Coastal
Marine Bank GP
2/15/2017 Construction Patrice Parker Trust 1349 $600.00 65117D JD rct. 3539D

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ?—a �rI ce- 's
q (Na e of Aroperty Owner)
property located at d 6 ����'��''��
(Address, Lot BI ck, R , etc.)
', t-
on Ca / , in C , N.C.
(Waterbody) (City/T wn and/or County)
The appli nt has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I 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)
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 yo wish to waive the setback, you must initial the appropriate blank below.)
t/Aio-
wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property caner Information) ;(Adj cent Pr rty Owner Information)
Sign nitre*
re C q�_n u r� F � I• S
Prime�rr or T pe Nam e Print or T Name
17. .r , r.. r -1 n�I� I 0.11 f I�,..;

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I CC' C� 1If s
(Na a of roperty Owner)
property located at L%� 4�'�'
(Address, Lot BI ck�R, etc.)
on ca', � , in , N.C.
(Waterbody) (City/T wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio��
✓" 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 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.)
'✓ Co wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Propert wner Information)
Sign�re
Prir�_or Type Name
(Adjacent Property Owner Information)
Signature
Print or Type Name ,�

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