65035D - Rouse

_JCAMA / c-' DREDGE &FILL ((J
GENERAL PERMIT Previous permit #
;New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
f ❑ Rules attached.
it Name K,/ { ( ,. Project Location: County
Street Address/ State Road/ Lot #(s)
,AM,". V lie, State Alt... ZIP 7Y'A
►� )G' ` ij'Q' Fax # ( ) Subdivision
Eed Agent - �.r � . K , City ZIP 2 �'14L
❑ Cw `QEW fapTA Q.ES ❑PTS Phone # River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (-,i p4a lS 0T G Ana(
❑ PWS: ❑FC:
yes / no PNA yes (/ n6 , Crit.Hab. yes / no Closest Maj. Wtr. Body o
f Project/ Activity
(V_
)ck) length
)ier(s) k (,
.ngth
amber
id%Riprap length �>�1
g distance offshore
ax distance offshore
hannel
I
ie Length
not sur� yes
, notsurd' yes
rium: n/a yes
yes
Attached: yes
ing permit may be requi

DENR LAMA Daily L;neCK Log for WIKV
Date
Check
I
Check
I
Received
Check From (Name)
Name of Permit Holder
Vendor
Number
amount
Permit Number/(
3/2/2015 Pacula Builders LLC
Roy Gilbert & Brenda Madison
First Citizens Bank
1138
$600.00 GP 65079D
3/2/2015 Pacula Builders LLC
Dennis Michael
Security Savings Bank
1847
$400.00 GP 65102D @$20
Dennis Michael
GP 65103D @$20
3/2/2015 David Lee Builders, Inc
Edwards
B of A
19918
$100.00 minor fee, TB 15-(
3/3/2015 Carolina Marine Construction, Inc.
John Clark
First Bank
9496
$400.00 GP 65093D
3/3/2015 East Coast Engineering & Surveying, P.C.
Dinah Gore
First Bank
1308
$100.00 minor fee, SB 15-(
3/4/2015 Hunter Development Corp.
John Ledoux
Yadkin Bank
22714
$200.00 GP 65037D
3/5/2015 Coastal Marine Piers Bulkheads LLC
James Harren
Wells Fargo Bank
20059
$100.00 renewal fee, MP 1
3/5/2015 Mark D. Kelly
same
PNC Bank
795
$200.00 GP 65121 D
3/6/2015 Lighthouse Marine Construction Inc
Rick Rouse
B of A
5269.
$600.00 GP 65035D
7

MC Division of Coastal Mgt. Habitat Impact Computer Sheet
Permit #;Q
Applicant:
�j�
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.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp im�pac1ts
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
J
Dredge ❑ Fill ❑ Both ❑ Other
!N
v
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 ❑

ADJACENT
I hereby certify that f own Property adjacent to
property located at '1 b -It-1 -7+1-- c L (Name Or Property Owner)
on 5�4k� (Address, Lot 010c�Road, etc.)
in
(Waterbody) —, N, C,
(city/Town andlor—C�ounty)
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal
I have objections to this proposai,
DESCRIPTION AN )R DRAWING OF PROPOSED DEVELOPMENT
(11761vklidal Pr0P05iq9 development must fill in description below or attach a site drawing)
1�o 6 a4
P41illk"C—aa 61L.;
WAIV9 -SECTION
I understand that a pier, clock, 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,10f You wish to waive the setback. You must initial the appropriate blank below')
A I `
I do wish to wawa the 15'se"back requirement
I do not wish to waive the 15'setback requirement.
(Pr petty 0 er Information) (AdJac Property 0 ner nformation)
Still ii I
7
Type Name Prrnt of p Name
g
Mailing Address
Mar' ' naA41ress
J

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to pick aa". 'c s
property located at
(Name of Property Owner)
� D 4� `� "�'� s
(Address, Lot, locks Road, etc.)
on `� S� A Cum in $%. t J 0--` `1 �P�ii,tl� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
logation.
9 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)
Axre'c' 00 Wawa �c 5 wwll W A w )act Ui µql
a4 9e-Pk-ce a5
5 fa-' Y-*2 k-4 dtgoo.�'-f P90"Oe-z'
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.
z
rty O er Information)
Signature
McK Oo"�e—
(Adjacent Property Owner Information)
,x rui e f� 1
Print or Type Name
or Tvpe Name

F-61-1 1.8
1- 1 T- - �----�' 13' -I-� f' =I - 12'