68532D - Wiggins

'AMA / ❑ DREDGE & FILL
iENERAL PERMIT
1,lew '—Modification El Complete Reissue El Partial Reissue
A B
Previous permit #
Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources t
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC_ 1 ` oo Rules attached.
Name 1 Project Location: County
oo � , pS1CQ C - Street Address/ State Road/ Lot #(s)
7 State ZIP
V -2 Lk0-Mail Subdivision `��
ii
:dAgent it ((3Y1SVyyC�-by1 City - M 1 i N ZIP
C W �W )(PTA ❑ ES ❑ PTS Pone ( ) ver Basin l lnM
❑ OEA �❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body at
❑ PWS:
Closest Maj. Wtr. Body
(es / /) PNA yes / 60
Project/ Activity
rcy, hkc
:k) length I K 1_ UT
xform(s)
Platform(s)�Q_
ngth
nber
I/ Riprap length_
distance offshore
uc distance offshore
cannel
bic yards_
np
ise/ Boatlift
iulldozing
2
a
(Scale: (' Z
❑ See note on back regarding River Basin

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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
,veriy Eaves Perdue Braxton C. Davis
avemor Dkector
AGENT AUTHORIZATION EQRM
Date: t�
no of Property Owner Applying for Permit:
Dee Freeman
Secretary
Name of Authorized Agent for this project:
noes Mailling Add['
ss: Agent's Mailing Address:
NJ
,ne Number fYff Phone Number (S `0) V d o 3
qua-466 WP74L4
li€y that i have authorized the agent listed above to act on my behalf, for the purpose of applying
ind obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located st
certification is valid thru (date)
p -�i `7-7
Property Ow i ature
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that l own property adjacent to
property located at
! (Address,
on �kat Q in_
(Waterbody)
a.etcs O'�A aSaa
(Name
of Property
IN &% - 1
Block, Road,,etc,) _
(CitylTow6 and/o/County)
i ks 's
r,' A
Cad. 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
WAIVER SECTION
1 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) (A cent Property Ow er Information)
Sf tore Si nature*
�i�y �. G q IyS amps k\ Gar nor
Print or_TY� e N e 1 P' t or Tyile Name
Qf 1'� "tom a- 11(O V0.Y)V,Ir Jfi �h
Maikpg Address _ Mailina Address

08/25/2017 11:05AM 9198542492
CHARLES WIGGINS
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby Certify that I own property adjacent to
property located at _-_ 0 6
(Address,
on Oexv..Aj B� ni
(Waterbody)
r[cS 0_JAA Su�Qk U_, I
(Name of Property Owper
t-z d H e
ock, Road,,etc,). _ J
(City/Town and/a County)
PAGE
The applicant has described to me, as shown below, the development proposed at the above
Io i n.
I have no objection to this proposal.
I have objections to this proposal.
.__.-. __ DESCRIPTION_AND/OR DRAWING OF PROPOSE[] DEVELOPMENT
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 -
do not wish to waive the 15' setback requirement.
(Property Owner Information)
e Ul--'-'� b
Sf ¢fure
P&1 or Tyke N�r�s j
..I ,
(Adj nt Property Owner Information)
� ac�iS
Print or Typa Na e

2 -� I
1= 6P14 T n/ c-7 p a c- k
I S F

NC Division of Coastal Mgt. Habitat Impact Computer■�
icant: k6k \A'C
� c, application.
for the
t e ABITA disturbances
cribe below
measurement found in your
Habitat code sheet.
values should match the name,
and units of
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Anticipated final
(App lied for.
(Anticipated final
(Applied for.
Disturbance
disturbance.
DISTURB
TYPE
Disturbance total
includes any
disturbance.
Excludes any
total includes
any anticipated
Excludes any
restoration and/oi
bitat Name •
Choose One
anticipated
restoration
and/or temp
restoration or
temp impact
restoration or
temp impacts
impact amount)
temp impacts
amount)
Other
5
Dredge ❑
Fill ❑ Both ❑
Dredge ❑
Fill ❑ Both ❑ Other
Dredge ❑
Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill 0 Both ❑ Other ❑