68061D - Watkins

�CAMA / ❑, DREDGE & FILL
806 1 A B
ENERAL PERMIT Previous permit#
New ❑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 15A NCAC
❑Rules attached.
it Name L V" Vl Project Location: County(t—
h ` o ��r - Street Addres-s-
� /7 State Road/ Lot #(s)
j (6 f-b7orr State ZIP /
E (31A ! Ll-31q 3E-Mail Subdivision {
:ed Agent — City S �, � � � U ' 1 ` ZIP G ��
❑ CW
KEW A
tH
❑ OEA
ElHHF
❑ PWS:
e Length
not sure yes ;o
ium: n/a yes J
yes 4ttached: yes
ng permit may be required by:
Local Planning lurisdiction)
❑ ES ❑ PTS
❑ USA ❑ N/A
Phone # ( ) River Basin L "M
Adj. Wtr. Body a
Closest Maj. Wtr. Body W
(Scale: ( '
❑ See note on back regarding River Basin ri

AC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 0 k N � (/Vq S Permit #: (o fo 6 i
Date: Z/
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 FIN AI. Feet
(Applied for.
(Anticipated final
(Applied for. (Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance disturbance.
Choose One
includes any
Excludes any
total includes Excludes any
anticipated
restoration
any anticipated restoration and/or
restoration or
and/or temp .
restoration or temp impact
temp
I impact amount)
temp impacts) amount
o w
Dredge ❑ Fill ❑ Both ❑ Other
��impacts)
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 Q Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Ln
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_ ru Certified Mail Fee
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Extra Services & Fees (check box, add fee p rU ❑ Return Receipt (hardcopy) $ e)
C3 ❑ Return Receipt (electronic)
C3 ❑ Certified Mail Restricted Delivery $
C3 ❑ Adult Signature Required $ • L' • OCr—
Adutt Signature Restricted Delivery $
C3Postage —�
rSent
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Oostage and Fees
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"0 r-1
� ndApl ff6l of P(f
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9
0459
01 _
Postmark
Here _
02/02/2017
Domestic maii only
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S WWHAN ,
m GA , 31, 419
nJ Certified Mail Fee
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Extra Services & Fees (check box, add fee a V 1
e)
,-, , 0 Return Receipt (hardcoovl t t r r

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to J CA n * 6 trnt, �J 6A)-h7 's
property located at (7 % ] `% i f 1 a �' Dot 5�(Name of Property Owner)
, II (Address, Lot, Block, Road, etc.
on �WMCiM1l W-A�i , in 3TAild4k ?.�h k , N.C.
(Waterbody) I (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
ST-- I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
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.)
t do wish to waive the 15' setback requirement.
F ly-1 ' �-rdo not wish to waive the 15' setback requirement.
(Property wn//er,, Information)
Sigz. gavre
Print or Type, N?me Q l �i L l 1-7" V 11 �l.val�
(Adjacen Property O ner Information)
Signature*��
Print or Type� Name - P�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J b kti \ �'kj- {(tom 's
k ,,,(Jdarp� of Property Owner)
property located at V i
� (Addres_
on 1— J . l , in
(Waterbody)
Road, pkc.)
(City/Town and/or County)
N.C.
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)
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)
Signature
Print or Type Name
(Adjacent Property Owner Information)
Signature* I p��r�
Print or Type Name f