64639D - Gerke

64
LIVIA / ❑ DREDGE & FILL -42
`X
iENERAL PERMIT
Previous permit#
Vew ❑Modification ❑Complete Reissue OPartial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources ---� '' - f
in of environmental concern pursuant to 15A NCAC 1 ,ules
)astal Resources Commission an area
�i /i
attached.
Name 1 Y1 Gt'`
Project Location: County
Ctr '- -
Street Address/ State Road/ Lot #(s)
state N ZIP
i
�) Fax# 1)
`1 V, �Yi. tic l..
Subdiviiision N
City 't'� C f Ll ��L(� ZIP G!�� �A
:d Agent
1�i
hone # (���) Jl?�// River Basin L.JJ INA
ElCW ©EW QPTA ElES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body o--k nat
❑ PWS: ❑ FC:
Closest Mai. Wtr. Body
des / no PNA yes /IInno� ; Crit.Hab. yes
Project/ Activity
:k) length "i 71 '1 ,
(s) 1LTX IZ . lox
ngth
:nber
d/ Riprap length_
distance offshore_
m distance offshore
cannel
bic yards
np
ise/ Boatlift
{{ X i J
lulldozing
&N1P
lix 1V
ie Length
N�
not sure
yes ? no
gs: not sure
yes (no
\yno
,rium: /n/a
yes.
Attached:
eyes; no
! yes'
(Scale:' !/
ling permit may be required by: ❑ See note on back regarding River Basin

IC Division of Coastai Mgt, Habitat Impact Computer Sleet
pplicant:Ai -t Permit
late:
--/V s
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet.
abitat 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 fina
disturbance.
Excludes any
restoration and/c
temp impact
amount)
Dredge [I Fill El Both ❑ Other
8 l
(� `
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 ❑
r;
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

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Tul.05.2015 04:21 PM Richardson Const & Marine 9108425597
PAGE. 3
ADJACENT 11M1114IAN pJL10 pERTy OVVWE R STATEW r
(FOJ?APM&z71•0ORt74G,PLr"G"0,jTLU7iBa.�1Tdf4USe
f hereby cert4 that l ownproprrty adjacent toIsLn-,s
{ me o�Pro}aerty Ow».ex)
Prnpertp located at
Black, .R.6ad, etc.;
an c--\
i1a
ffa t+P,i•bod�
P}
ovt and/or Gouuty)
A kicant's phone #` as Lt L-.a 4e ailing A,d.dress:--.'Q
. the dova��.!�`7_�U low.
k has cicsGztbed tic rne, as sitnrvn hrlow, e topmer�t be i8 pXopcssing ai thaS k�aza+ar4, and, Z
have Do object ons tQ his proposal. I u aderst M tlxat a plWmcoring gili:s 1 boatii J boathouse
anui be. sa buck a u3 uizctm distame of h"freer feet (15) from my W-a 0114arian aocoss URIC.-S
waived by xne. (1f you wish to waive the setback, you must iOit%l the appropriate bI ik
below)
---- _ I d._—not wish to waiive.
I do wish to waivethat sefbackrqaerr,cr►l.
D CRTPTION AND/OR likA` W-, 01? PROpo s DI7, 'Mo F
rTo be.fatted a,7by ifrdls,tdual p,6jmsii�q drvelo +tnrr►t� FI4 FZdT:
(InFOXMa boxi for Property ty'rter A.pplyi,ag
for Permit)
�ailiztg Address
CityfS �jp ---
i'Itil,�arian PrapertpCis „Qr Itxfoctrxakina} r _ �
.P;-int or A'IAaI ne
��ir�-q2q

Ju1.06.2015 04:22 PM Richardson Const & Marine 9108425597 PAGE.
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIF-Wi?YIC7U141'11%GP1LrNG—V1B04TL1FT1B0AT.F,fO[7,5Ej
l hereby certify that I own property adjacent to —IL ay-IILy— _��'s
{Name of Property Owner}
property located at
Block, Road, etc.)
on
(Waterbody) (Town, and/or County)
'�
Applicant's phone "� - Mailing Address: 5 fj7C%L�Zwsfarckt-
He has described to me, as shown below, the development he is proposing at that location. and,1
haN,e no objections to his proposal. I understand that a pier/mooring pilings / boadift / boathouse
must be set back a minimum distance of freer, feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate bfank
belovv,)
I do not wish to waive
I do wish to waive that setback requirement.
/------- --------------- ----- ------------- --.---------- ----------------------------- ------------------------------.-
�o DESCRIPTION AND/OR DRAWING OF PROPOSED DEWILOPMEN'F:
�►�� LL (To &e filled in by individual proposing development)
C,1-3nSf11rtiC L+ v- �GI�'..;._X C_�� �i7S �A0"(, Li
r
(Information for Property Owner Applying (Riparian Property, Owner Information) for Permit)
,ry
Mailing Address Signature
City tale,' ip ri Print or. Type Name

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BOAT LIFT
CANAL