692181D - Reed

CAMA / ZbREDGE & FILL SZ 11
iENERAL PERMIT
New ❑Modification ❑Complete Reissue El Partial Reissue
A B
Previous permit #�tZ
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources / •/j , (�i `
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC Rules attached.
Name �� c �� � y' Project Location: County
�d Street Address/ State Road/rLot #(s)
. d, /4 State I P � � � � i I -a' tif/1f
p L�
l� lt7 5- r35' Subdivision
E-Mail ��-
f�P
ed Agent
❑ CW g)Ew QPTA [fS ❑ PTS
❑ OEA [IHHF ❑ IH /❑ UBA ❑ N/A
❑ PWS:
yes _no_ PNA yes / no
f Project( Activity
)ck) length
latform(s)
Platform(s)
:)ier(s)
angth
ember
ad/.RiPl-ap length
rg distance offshore__
iax distance offshore_._
ubic
imp —�
)use/ Boatlift
Bulldozing
line Length /
not sure yes
orl n/a yes nn
s: yes o
:r Attached: yes n
�7 /".1e, b-'I
Phone # ( � River Basin
Adj. Wtr. Body /1/r `?` bu na
Closest Maj. Wtr. Body
(Scale: / J 1!
i / 4t„i' 4 ❑ See note on back regarding River Basir
(ding permit may be required by.

NC Division of Coastal Mgt. Habitat Impact COMPI
Applicant:
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.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
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
temp impacts)
FINA
(Anti
dish
Excl
rest(
teml
amo
Dredge ❑ Fill ❑ BothOther ❑
Dredge ❑ Fill Both ❑ Other ❑
C�4
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to E I (, RPej I
{ (Name of Property Owner)
property located at 4/ 4'a 1,2" Y
(Addfess
on �sr Al", in
Waterbody)
:k, Road; ftp.
pens
(City/Town and/o(County)
, N.C.
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 tyouu wish to waive the setback, you must initial the appropriate blank below.)
y I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr erty Owner formation) (Adja ent Property Owner Information)
,sYknature iq ature
(Lad ✓fli n E �P DO G ��lf�.
Print or T pe Name Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L f, C 8 eed 's
(Name of Property Owner)
property located at
Al"dd ess, Lot, B c,, R ad, t .
on If Al /, in vs N.C.
Waterbody) (City/Town and/o(County)
The applicant has described to me, as shown below, the development proposed at the above
location.
E�� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development mast 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.)
wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner formation)
'51gnature
Print or Type Name
i / .4
(Adjacent Property Owner Information)
Signature * n
,C6 le s el- , l4-0
Print or Type Name 0

7
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