69217D - Stewart

�CAMA / ❑ DREDGE & FILL -1
3"ENERAL PERMIT Previous permit#
;blew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 6-7 `
.oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
AA
t Name (A Project Location: County t/%A-�
L L Yi Street Address/ State Road/ Lot #(s)
AL
C State ZlP }0 _� f)� 614A �—
�) 1 10 E-Mail {{ -- Subdivision rr
ed Agent ' _ G N jr� Ch� V" City � It to 1�- K( N ZIP A g�i
River Basin
%, 6�.,�` aa
❑ cw �TA El ES ❑ PTS Phone IF 1 j �.� � � �3v� I LA/VIA
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body( CA V1 CAA (nat
❑ PWS:
yes / nt� PNA yes / rV Closest Maj. Wtr. Body
f Project/_Activity ( O Y'0)Ttt !YM (�
V \ ,�\NU(G
>ck) length is
i
'latform(s)
Platforms)
pier(s)yoffshor
_
ength
ember
ad/ Rip--
,g distiaxdis:hanne
Bulldozing r
f
ine Length _')"
not sure yes P. 1
orium: n/a yes
s: yes
r Attached: yes
(Scale:' `-
v
ding permit may be required by: -TCAA/Vk �� �r �>f �'1 1 ❑ See note on back regarding River Basin

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant: (G y pa^aVA 5fG�v"'*'q TV a M 1' �
Date: O G,a �/HIZ
Describe elow AT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
M
(Applied for.
(Anticipated final
(Applied for.
(An
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disl
Habitat Name
Choose One
includes any
Excludes any
total includes
Exc
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
tern
ternimpacts)
impact amount)
_temp impacts)
am
Dredge ❑ Fill ❑ Both ❑ Other
1
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly haves Perdue Braxton C. Davis
Governor Director
certify that I have authorized the agent listed above to act on my behalf, for the I
)r and obtaining all LAMA Permits necessary to install or construct the following
r• 3 _
For my property located at
This certification is valid thr (date) _ �—.---
property owner signature
sk
D" Freeman
ecretaty
/-36#fib
Date
z� _

ADJACENT RleAR1AN PRQPERTY C?WNgR 6TATEMENT"
I hereby certify that 1 own property adjacent to
property located at I U i'i
J (Address
on in
(Waterbody)
The applicant has described to me, as shown below, the development proposed at the
locatia
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must iff In
description beie�w or attach a site drs
J%4TAW
hoc-I�-
1�1 U K(-(N6
ID oc41/-
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift,
must be set back a minimum distance of 15' from my area of riparian access unless w:
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
mil! K_ I do not wish to waive the 15' setback requirement.
(mation) (Adjacent Property Owner Inform
Sig wire Signature*
,)A,
Pant or Typeame .. _.ft — Ptint or Type Name

ADJACENT RIPARIAN PROPERTY QWNER STATEMENT
! hereby certify that I awn property adjacent to V
e of Property Owner)
property located at IEa PD i 1\1 T .
(Address, LcBlock Roaon
ta�i=----'--
r
(Waterbody) (City/Town and/or County)
i. applicant has described to me, as shown below, the, development proposed at thi
loc
~a I have no objection to this proposal.
= I have objections to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development
Oil in description below or attach a site t
a
[ c VilIM P .Y
'4
r 1 4, r � Via,, s.F� �,•$ � �4� v '`gr.V� y' > { N �`' �� .. � �.ir�
i`'
- _ } n}..ar D:'AJ rpi - xn R ..+-. ..y....+. +sY.e nr•^ & } Je� ..
- WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, li
must be Set back a- minimum distance of IF from my area of riparian access unless
me. (if you wish to waive the setback, you must Initial the appropriate blank below.)
I do wish to waive the 15' setb ui rem 11
I do not wish to waive the i 5` setback reou rement.
(Property Owner Information) - (A ace t Property Ow Ir
tyt
Sig ture ''rrc�t urc
�� r ,at)0l` 1 tC
rm-.:-A _ . .,.,., el^,ti Print or Tive Name -

INSTALL -DOCK, RAMP, FLOATER
113 HIGH POINT ST.
HOLDEN BEACH, NC 28462
8' X 16'
10'X5'