67195D - Yankalunis

I CAMA / ❑ DREDGE & FILL
3ENERAL PERMIT
]New ❑Modification ❑Complete Reissue
Previous permit #
El Partial Reissue Date previous permit issued
rized 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
❑ Rules attached.
it Namerr �A I?�I
ILKAl . v 4 )S Project Location: County ; + ,_ -
�d b 'A-t N Street Address/ State Road/ Lot #(s)
�C11A�� State W ZIPy%SdQj
`ltrp�g ". �'S4E-Mail `+d►"►(tAtJn"S1p; :4.ne Subdivision LANG-- Q'('-
:ed Agent ZIP
❑ CW ❑ EW ❑ PTA )1ES ElPTS
ElOEA ❑ HHF ElIH /❑ UBA ❑ WA
❑ PWS:
yes / no PNA yes
F Project/ Activity
,ck) length
atform(s)
Platform(s)
iier(s)
',ngth
mber
d% Riprap length d
; distance offshore {
uc distance offshore_
cannel
bic,yards
np
e Length +f" ;3cn,
not sure yes now
ium: n/a yes no
yes no
kttached:
Phone # ( ) River Basin CF�
Adj. Wtr. Body PA I L L C42-ePa _ (nat /
Closest Maj. Wtr. Body bp-:;p' I L C"O 1) Nt�
(Scale: �h
rig permit may be required by: T,)-tN ❑ See note on back regarding River Basin n
Local Planning jurisdiction)

NC Division of Coastal .Mgt, Habitat 1M.Pa t tdomp> ter Sheet
Iv(1%5
Applicant:
Date: Z
Describe below the HABITAT disturbances for the application.
Ail values should match the name, and units- of measurement found in. your
Habitat code sheet.
TOTAL Sq. Ft.
FINAL. Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
Disturbance
(At
dis
DISTURB TYPE Disturbance.total
' includes any
disturbance.
Excludes any
total includes.
Ex
Habitat Name Choose One anticipated
restoration
any anticipated
re;
restoration or
tern im • acts
and/or temp
im act amount
restoration or
ten h acts
ter
arr
�D
Dredge ❑ Fill ❑ BothV Oth
Dredge ❑ Fill ❑ Both. ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge. ❑.
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill 171
Both 171
Other [�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to `\/1 I!, �, ;J�,� /� / , , s s
(Name of Property Owner)
property located at j � � /-���� 5 C-�
(Address, Lot, Block, Road, tc.)
on U 4 in 4-e
N.C.
(Waterbody) ( ity/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loc
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual development must fill in description below or attach a site drawn
r��F«I,�
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set t
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
the setback, u 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
//!/--% Imo- /' ` , c-�
Print or Type Name
Owner Information)
Si u � �)
1'rir rT e Name��l

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f�/ 1 1 l 4 , J �5 l�,�� 's
nn
property located at _ , (� L 1��� , L �-- (Name of Property Owner)
(Address, Lot, Block, Road, etc,)
on (_��,✓v� 1 ��-t�� �,�, in &" . -t-cf- � , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loc
V 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 drawn
+ C G Ll J
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set t
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
the setback, ou 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) (Adjace operty Owner In tion)
Signature S' at re
���„ 1 ct stile s
Print or Type Name Pn e ANawerl

iY.
6�
fos
YSICAL SUR
Nz� /
y xZa " pier v✓/ 2 &_
A-