68084D - Reauland

f����^ -. � +, �� _
-vNC Division of Coastal Mgt. Habitat Impact Com
Applicant: 1` �✓C .d
Date:
Describe below/ the HABITAT disturbances for the application.
All values should match the name, and units of measurement found it CDaits
TOTAL Sq. F "'"'
(Applied for. MHCDO
DISTURB TYPE Disturbance tot
Habitat Name Choose One includes any
anticipated Tyler Crumbley
restoration or
l-� g LPO
Dredge ElFill ElBoth ElOther
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Tara I J
DW Review EZ
Owner V"

17/2012 09:13 9105799096 GRICE CON PAGE
canna i I � oAEooE a r=i
ENERAL PERMIT
0 68084 A B
ew 1Modification I (Complete Reissue I .Partial Reissue
Previous permit #
Date previous permit issued
t ized by the State of North Carolina. Department of Environment and Natural
sources
he Coastal Resources Commission In an area of envirorwnental concern pursuant
I SA NCAC
(�� V J
A —
Icant Name 1(�.'f17V, a Pro
Rules hed.
t Locatlon: County. t�/�/Vl�.f;/ 7[
ess '`Z Cj win 1 is per St
Address/ State Road/ Lot #(s)
Wt�4.5I�ipiMq State IVC ZIP Z i J� �p._... )
h`� S�w14c��� Ar.
c
`i )0) Sl °�' 1 1 J --Mail Sutx
ivision
torized Agw C0-46w l
t � . City
...,w..------
�.
► k 17cQ N d
_..... ZIP 2 O
cted � i ew XEW A ES r- M Pho4
a # ca ) M -111.6 NO River Basin (�,Vi1M
s
( ): r OFA I HMI lH - ueA '1 ww Adj.
tr. Body (>16 � � d C+ w K �
L 1WS: _
V: yes / ® PNA yea /� CIO
t Maj. Wtr. Body_----
e of Project/ Acdvih eAlk"Oa cc
ow h ]r 6ew% L. (Scale: " = i
r (dock) length I � 1
D S to I Ito
$ �b�l��C p�bid Platfoi �IPbltfvrm(a) �rG j, j do
su^g ... i
)er pie►(s). on l«lgth — g Q 1
I
numbw
ilhead/ Rlprep length �—. _ _ �•
V�
an distance offshore
Max distance offshore....
_ in. channel
cubic yards
t ramp ... - _.� _ ...._
thouse/ Boadlft r
ch Bulldoz _..-_
or
.- -
10
-ehne Lan h i+ j
1: not sure yes I
p
atorium: n/a yes
W'
;os: yes
rer Attached: yes
gilding permit may be required by: ire 'See note on back regarding River Basin n
xe Local Planning Jurisdiction) r/ ///� a!'���1 �I /��..J41_—_ ■ A O I T1 I / .1 _ 1H �1

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: R/CI�— -�
Mailing Address:Or
i,J1� 4w.-- c�G �Qwt � l 1
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining aft -LAMA permits
necessary for the following proposed development:
at may property located at
in () rLn A, County. 2 �
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related -to --this
permit application.
Property Owner Information:
A""-*
/—
Signature-
rCl JZ� t� a
Print or Type Name
Title

U�
G
=�
to Q
Postrru
Here
02/0?,/2