69161D - Wellen

i In"I ! T 4

°LAMA I DREDGE EE FILL N 0. 69161 A B C
GENERAL PERMIT Previous permit #
ew Modification Complete Reissue Partial Reissue Date previous permit issued
As autt4rized by the State of North Carolina, Department of Environment and Natural Resources - 7 ( 1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC_ r 1 f " 1 �✓
'Rules attached.
Applicant Name V (° _ Project Location: County
Street Address/ State Road/ Lot #(s)
Address G'L 4., _
City �Ct � "'{ State � i)PO `C � 16 V y tG � � r
Phone # ) g 0-_ ) `# A -Mail _ 4 a"OSubdivision V/IVA 4_6
_._ Ci �## t ZIP f,vi �1
Authorized Agent �`" tY -
Affected t
CW �w ( A ES PTS Phone # ( � River Baisiin�c V. V
AEC(s): OEA HHF IH URA WA Adj. Wtr. Body f 10( 5 6 .1T f
! _. /man /u►
Pws_ ___.- y
oRw Closest Maj. Wtr. Body
yes / PNA r/ no
Type of Project/ Activity
A 0( K ov °vvd �
Pier (dock) length Ji !' .i
f7
Fixed Platform(s) TL
r
Floating Platform(s)
Finger pier(s)
Groin length
number
BLtkheadt Riprap le th
avg distance (shore
matdsta offshore
Bas.n,channel
cubic y rds
Boat ram
Boathouse)
Beach Bulldozing
Other V+ r
91
(Scale:
Y 'J,
111111114
Amx-
.�� iA Y"� �t•Y i � ,
_ `VnC-s .
16' y.
x luGl
totj�-- `1
Shoreline Length
SAV, not sure yes
Moratorxim: Ma yes . y H(A
Photos: yes —\tFt" C A/Cfdy
Waiver Attached:
A building permit may be required by `,cy See note on back regarding River Basin runes.
( Note Local Planning Jurisdiction) ��}}
Notes/ Special Conditions a i 1 � � �� � 11 Koo fi I J 6 � � i5 1 ` i<�f � � f' �t 41 af`

-
..��.I
11V1{iGx
ii.umuer
i amount
FUMMents
5/2/2017
Gregory or Kathleen
same
Tower
3556
$200.00
GP 69161 D
Wellen
Federal
Credit Union

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant:
Date:
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.
FINAL Sq. Ft.
TOTAL Feet
FIt
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis'
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex(
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
temp impacts)
impact amount)
temp impacts)
am
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 ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to G re o yr . V . We -I le-,, I
(NaMe of Property Owner)
property located at y % X peep `Dr; v e-
(Address, Lot, Block, Road, etc.)
on 4o-k Folle in f3 ol;V! C N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
do
X I have no objection to this proposal.
I I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Please sec pfae�,,J, ReFueJf is to vse 6L4f nco
EXCee J t-he l 5' sef bA c k a v'eci. E Berl -,He-let
W , I I Io e rn-, a d e - - o , , , ; , ; W us e o -F -t- ke se i ba C- k
carev'- too.Se is +' a ccesS
e,�/o eXceeJ:'17 CA 1'1 A resf-%ci%�-,s of
e r. Ttianks
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If yqu wish to waive the setback, you must initial the appropriate blank below.)
)C I do wish to waive the 15' setback requirement.
,fi 1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (A 'acent Pro e O r Information)
Ali� (A. L;(,A- x �7
SignaMiV Signature *
G-ea o,.i R.G,-9e Ile-, joa ►-r-e. 11 An derc o,
Print or Ty e Name Print or Type Name
y 9O� Deep L.J. {-e- D 4/!? 7 Q e e „o 6.1 a +er dr.
Mailing Address Mailing g Adds

NC Division of Coastal Management
Cashiers Official Receipt 4074 A a ( ;�
Recervea Frwrr. �rlL `�.,yt\Q:il 'J \'
Pwmn Na. �`
APPl,cant's Name
p7
ProlectAuarest:._,_,--1.J�.�Y.?P!
Plea" ratarn recapt /w ypur Worpa as Mool of
Payment for Pennrt roaueq.
9p11attx0 of Agem nr MWrcant. y■* ^�
Sigryllwu o/ F,el;l RePresnrtalive.

ADJACENT RIPARIAN_ PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 6.-eo- t R . k& l� I
IJ ( ame of Property Owner)
property located at Li % 0 Pe 42moo, �rf 0 r
Address, Lot, Block, Road, etc.)
on L oc lj ljood Fo llry in 8D /; v,`g , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
✓ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
ea.se-
ves f is o vse
buf n o f exceed
,Sefback Areal.
vc—y c,f"'fjol e,
I %e madr '+a rt+iniM:re
Ike vse m; +fie Sed back 4fra. Pwf,Po.,r s+o-TccesS deep cnote�
^�i9r boaf w/o eyceedj,y CAMS ci ls.,st'l
©� f I Pr-. Th J;'Ss'.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sign
G"rPq Bar R. +.ter I le-,
( -acent Property Owner nformation)
/06AffdAc/i
Signature * /1
L Cjrie ) I A-1 Jr --so,
Print or Type Name
Print or Type Name

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LOT 13, SECTION TZ. PHASE 3, WINI
SMITHYILLE TOWNSHIP, 8
BRUINSwICK COUNTY. NOR
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DRAWN BY: C.KENNEDY SCA
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