68039D - Southern

CAMA / El DREDGE & FILL �1� 3.13.1�1 A B i
iENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources I :>astal Resources Commission in an area of environmental concern pursuant to 15A NCAC V 1200
F� Rules attached.
Name � e��n n;�C�(_P_ — � Project Location: County �Xt�ttJ C
S8o8 EF �� Street Address/ State Road/ Lot #(s)
c State /QC ZIP 85 -
- I% S 1� nd � �
(qli ) 8Y/Z1- 2-1J19 MAC,
Subdivision
:d Agent rtt�� 1 t tAC, c�� l_ _ lr[iSl_Wi City �a'� 5�••,••� ZIP Z$ �fG
❑ CW ❑ EW ❑ PTA &S to t 5 Phone # () River Basir(--
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body (nat
❑ PWS: ,r
Closest Maj. Wtr. Body
yes no PNA yes / no
Project/ Activity
ck) length_
atform(s) _
Platform(s)
ngth
mber
d/ Riprap length 120
g distance offshore 0
ax distance offshore o
hannel
bic yards_
-np
ise/ Boatlift
ne Length j 20 r
not sure yes n
mum: n/a yes no
yes no
Attached: yes no
C�
(Scale:
ling permit may be required by:
❑ See note on back regarding River Basin

i4C Division of Coastal Mgt. Habitat impact Computer Sheet
s LLC Permit #:
Applicant:"�-�r�i"n
Date: 01 or,
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.
(Applied for.
FINAL Sq. Ft.
(Anticipated final
TOTAL Feet
(Applied for.
FINAL Feet
(Anticipated final
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
Habitat Name
Choose
One
anticipated
restoration
any anticipated
restoration and/or
restoration or
andfortemp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount
Dredge ❑
Fill ❑
Both ❑
Other
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
CDaits
_
Dredge []
Fill ❑
Both ❑
Other ❑
V1HCDO
-
Dredge ❑
Fill ❑
Both ❑
Other ❑
Tyler Crumbley
_
Dredge ❑
Fill ❑
Both ❑
Other ❑
LPO
Dredge ❑
Fill ❑
Both ❑
Other ❑
Tara
DW Review
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill [7 Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
(P /
Owner
Dredge [❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

xeceivea
3/13/2017
IflepoJ1LCu I ki"auic)
Allied Marine
Contractors LLC
First
Southern Premier Citizens
Properties Inc Bank
5385 $1,600.00
Comments
Permit 2 of 5
GP 68039D
@$400
BS r(

AGENT AUTHORIZATION MR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 5ak�%{LcM �rlfY116r / IDS
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
S•
-t'- - , - ...
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at1
in ,., �i,�k'l, County.
I furthermore certify that I am authorized to grant, and do in fact grant permission n
Division of Coastal Management staff. the Local Permit Officer and their agents to entE
on the aforementioned lands in connection with evaluating information related to thi
permit application.
Property Owner Information:
Signature
v � e
A
Print or ype Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
,,� P< �.
I hereby certit'y that I own property adjacentk (Name of Property Owner
c� �
property located at
t 4
(Lot, Block, Road, etc.)
j
N) in
on (Waterbody) CTown and/or County)
lod � �M
Applicant's phone f�:Q -a3a-a Mailing Address:
� ec" 1 r
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-----
-- -------------------- - --- ---- ----------------- ------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEi.OPMEN I':
(To be filled in by property owner proposing development)
►'L,tA I
--
---------------------`------------------------------
.�� -
(Information for Property Owner Applying (Riparian Property OwnerII
for Perin it)
MailingAddress
Print or Type Name
C' ity/State/Zip
Telephone Number
1'eleahone Number r, , g n

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed t0:
j1«lcl C
'+'I' I ew l
'e , I f 'V
'3 A I e, F04,
76*041
liilllllllllllllllllllllllllllllllllllllllllll
9590 9403 0319 5155 0688 08
2. Article Number (Transfer from service label)
A.
El
B. Pleceived by (Printed Name)
D. Is delivery address different frorT
If YES, enter delivery address k
3. Service Type
❑ Adult Signature
Cl Adult Signature Restricted Delivery
[Certified MaHO
❑ Certified Mail Restricted Delivery
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
Pil 1........._ J . I - 11
3010 1111 7848 8662 Restricted De _.
PS Form 3811, April 2015 PSN 7530-02-000-9053 t