66105D - Prior

rCAMA / ❑ DREDGE & FILL �( a
WNERAL PERMIT
rKew ❑Modification ❑Complete Reissue El Partial Reissue
6611.05 A B
Previous permit #
Date previous permit issued i
-ized by the State of North Carolina, Department of Environment and Natural Resources , ,.y�� ?
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 9.9
Rules atta hed.
Name 0 AZZk_&AK Project Location: County �C.f -
`�%_✓Gl/f,
* ,�„ s��dt /44� --O&� Street Address/ State Road/ Lot ,#((s)
UYSI? State a low
ZIP
( /�) :�6z -L`E-Mail _ '"' Subdivision
ad Agent
❑ CW
iAW 2VIi❑ ES ❑ PTS
❑ OEA
❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
yes / 1:..i'
PNA yes no
Project/ Activity
:k) length
itform(s)
Platform
er s
igth
nber
I/ Riprap length
distance offshc
x distance offsh
annel
iic yards
ip
�y r
Length ��
not sure yes In
um: n/a yes
yes
attached: yes
City W/" "47J h ZIP 7Z g�
Phone # (— River Basin C _!f
Adj. Wtr. Body pe-be-Ir;e-e nat
Closest Maj. Wtr. Body
(Scale: / /'I 2t
ig permit may be required by: /V/7t
_ocal Planning Jurisdiction)
❑ See note on back regarding River Basin rL

9, , 7/2015
Francis and Ann Prior
same
PNC Bank
720
$200.00TGP
66105D
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: i^� G� 5 �dt�CjL,� 0-Y rlki? r f ��
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
FII
(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
re:
restoration or
and/or temp
restoration or
ter
ternimpacts)
im a�cJt amount)
temp impacts)
arr
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 ❑

ENT
I hereby certify that I own property adjacent to ���)/e s
�. Name of Pro erty Owner)
property located at .lG�it,1l%AI'1'l
(Address, Lot, k B �o , oadLYJ/<clCa, etc.)
on �� �i�� in L�r�jD� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
.�r _ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development ,must f /l in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Inf m n)
P int ore Alame
Mailujc Addre V L'
v , cG� _
r�ilvL.Chahal7in -.
v (Adjacent Property Owner Information)
r /<--
,ti7l,n rlrnr
b.-ti
Print or Type Name
-7 = L i« _
Marling Address

RIPARIAN PROP
I hereby certify that I own property adjacent to
y
Name of Pro erty Owner)
property located at qn:�q � d �/jtl�4'�'I
( Address, Lot, B Q9k, f�oad, etc.
on l AL- inf / I.Y1/<t,l(5� 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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 must initial the appropriate blank below.)
X _ __ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Inf m n) (Ad' ent Property Owner Information)
t •c SY T rare
P iot or e ame P nt or Typ Name
Y46 &e-
��aili� ��A�d�die �7/• �Q(� Madmig ddress,
(r7���![ILG�v

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