68012D - Smith

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LAMA / ❑ DREDGE & FILL®12 A B
rENERAL PERMIT Previous permit #
�Iew Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to I5A NCAC o � ,,20Q
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- PWs:
yes / fio• PNA yes
f Project/ Activity
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❑ ules attached.
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: , 5 W` Permit #. 0 O ✓t Z
Date: 6 Z% 1 /2 0(— 7
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)amount
FINAL feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
bredge ❑ 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 [I Fill ❑ Both C] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
-

rk Smith
■ CI "It I
Holder
Greg
Holden,
Holden CresCom
Docks Bank
i.uuiuer I amuuui 1 70 ivumneri
Comments
GP SF rct.
3091 $200.00 68012D 3551 D
tcetunaitceauocatea

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2j6-6200419:20 9108429806 GREG HDLDa4 PAGE 01
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DIVIZION OF COASTALNMAGEMELn
APJ_ E�3,i EXPLAIM PROPERTY OWNER NOTIfICATIM/WAIVE&.. FORH
Names of individual Applying For Permit: Address' -of Property: � (p �
(Lot 'or Str"cet f , -Strecr ox Road,
I hereby certify that I own- property adjacent to the above -
referenced property_ The individual applying for this permit has
described to see as shown on the attached drawing the davelopvmnt
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
I have no objections to this proposal.
I understand that a pier, dock. mooring pilings, breakwater, boat
hansQ, list _ oust be not back a minims distance of 15'
from my area of riparian access unless waived by me. :(If you Irish
to waive the setback, you initial the appropriate blank
below.)
I..do wish to waive the 15tsetback rQquirement_
I do not wish to waive the 15'setback requirement.

44
I
i5
say.

Name Of Individual Applying
For Permit:
,
Address"of Property:
(Lot'or Street eet or Road, City 6 County)
I hereby cat-tifY that I own- prcepes7tY ad jacant to' tha above-
raferanc ed property. 2us individual applying for this pexmit has
das=Ibed to ae as shown a4 the attao drawing the davelopresnt
they are proposing. 1 description or drawing, with diaeasions,
should be provided with this latter.
I have no objections to this proposal.
l
I nttiderst �d that a pier, d6ek. mooring Pi nn"�s, bvrAakwater. boat
house, lift _ . wort be set back a Mi,nIMM distance of 15,
from my area of riparian aoceas unless waived by es. : (I! ycm Irish
to valve the satbtck, you MNkMt JftJtial the aWropriate blank
below.)
;yAo wish to waive the 15csatback.requi.rement_
I do not wish to waive the Is, setback requirement.
x'rinz name
gro• ?q4 - !170`i L�RHNR
; e5i;h- no suisber with Area Cods