67990D - Varnam

;CAMA / ❑ DREDGE & FILL V 6" ''> A B
IENERAL PERMIT Previous permit#1
Date previous permit issued
New -]Modification ❑Complete Reissue ❑Partial Reissue
ized by the State of North Carolina, Department of Environment and Natural Resources
',oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 0� + ' • `Q b
❑ Rules atta hed.
Name olrnin\ Project Location: County
M p V\ t K ES" S Street Address/ State Road/ Lot #(s)
�v State_ hJC ZIP 64 61 -1'AA 7V0 6 %ti h 5 bti
j�60 S' $L) E-Mail Subdivision
ed Agent
CWEW
'APTA [IES ElPTS
❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / ()
PNA
a / no
city SINa1\brt ZIP Z16'1
Phone # (HD) ��� L�ZHS River Basin
Adj. Wtr. Body hA 0�, Pl�c (%//i
Closest Maj. Wtr. Body M Ww
maim OL MP
m 0 ON ! a A E
11�!7i�rmm MEN,
!ngth
mber
.d/ Riprap length
g distance offshc
ax distance offsh
hannel /
ibic yards /
mp
use/ oatl' 3 YJ
I■�����������®Wlw /Itl
KIM
❑ See note on back regarding River Basin

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: ! OMfAl va ri' q w Permit #: (.-7 910 -- ll
Date: o � lolftol-7
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
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)
FINAL feet
(Anticipated fii
disturbance.
Excludes any
restoration an(
temp impact
amount
O W
Dredge ❑ Fill ❑ Both ❑ Other ❑
1-7
U
C W
Dredge ❑ Fill ❑ Both ❑ Other
D O
TOO
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 ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

'ayment Proccessing Confirmation
)ate Received 1/5/2017
heck From (Name) Varnams Docks & Bulkheads INC
lame of Permit Holder Sammy Varnam
/endor
:heck Number
:heck amount
Multiple Permits
Major/Minor
..:
7191
$ 200.00
No
'ermit Number/Comments GP 67990D
teceipt or Refund/Reallocated SF3486D

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 15a M M 4 va rr1Gi,m
Address of Property: -)-qq ThOMQ5
(Lot or Street #, Street or Road)
S hallo <& , iJ C.-
(City and County)
CA_
[ hereby certify that I own property adjacent to the above -referenced property. The individu
applying for this permit has described to me as shown on the attached drawing the development th(
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coast:
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390
Athin 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift *must be sE
)ck a minimum distance of 15' from my area of riparian access - unless waived by me. (Ifyo
wish to waive the setback, you must initial the appropriate blank below.)
'sign N
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Date
v -C L I/ An, P�rS v n) ��

DIVISION OF COASTAL MANAGEMENT
UAN PROPERTY OWNER NOTIFICATION/WAIVER F
Name of Individual Applying For Permit:
--------------
Address of Property:
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The indivia applying for this permit has described to me as shown on the attached drawing the development t
are proposing. A description or drawing, with dimensions, should be provided with this letter
�J A-,,/
proposal.
I have no objections to this
If you have objections to what is being proposed, please write the Division of Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 25405 or call 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be s
bck a minimum distance of 15, from my area of riparian access - unless waived by me. (Ifyc
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I Cc not wish to waive the 15' setback requirement.
;ign Name v
Date

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