64620D - Tally

JAAMA / ❑ DREDGE & FILL " 1� 64
'ENERAL PERMIT Previous permit #
New ❑Modification El Complete Reissue 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 15A NCAC lJ l
i
❑ ules attached.
t Na/me f,� 1 � T�(/ _ Project Location: County Q/uff
ZIP 78 -
ed Agent
❑ CW / t PTA ES ❑ PTS
❑ OEA ❑ HHP, ❑ I ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes / o PNA yet!�q
Proje V Activi
:k)
er(s)
igth
her
I/ Ri rap length
distance offshore
c distance "Iffshore
annel
is yards
r
r .
length
not sure yes
not sure yes
1m: n/a yes n
yes no
[[ached: nQ nn
_...
Crit.Hab. yes /G:/
b
Street Address/ Stake Road/ Loq #(s)
Subdivision
City /���.` 1�4 ZIP
Phone # ( v ) r Basin i
Adj. Wtr. Body nat
Closest Maj. Wtr. Body D�S� dL` 1
(Scale:
I
g permit may be required by: � r ❑ See note on back regarding River Basin r�

GP 64620D
_ M1

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Aw jat�
Date:
Permit #:
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
oose
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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
ll
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 ❑ Other ❑
.
Dredge ❑ Fill ❑ Both 0 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

GIVA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date s- jr-- lS
Name of Property Owner Applying for Permit:
May
Mailing Address:
� �-7
I certify that I have authorized (agent) /9 /1�1 1 r • ,n e to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) G�L
at (my property located at)�✓`�—
This certification is valid thru (date)
5/S/15�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORLVG PIUNGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Z)4 ,7 % a if e,3(- A�e is
(Name of Pr perty Owner)
property located at
(Lot, Block, R d, etc.)
on , in N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 21034? ZlSS Mailing Address: 72 f zg�o 1,0 G't .
He has described to me, as shown below, the development he is proposing at that location. and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
"IPA I do wish to waive that setback requirement.
t _
----- ------ --- ------=4=--�
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developmenl)
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
(Riparian Property Owner Information)
' Signature ?
?r C
Pri t or Type Name

91
v
C
n

Mete items 1, 2, and 3. Also complete
i if Restricted Delivery is desired.
/our name and address on the reverse
it we can return the card to you.
n this card to the back of the mailpiece,
the front if space permits.
Addressed to:
rloo`at Topsail LLC
Jumphrey Avenue
City,`NC 28445
A. Signature ❑ Agent
�(' \ � W
B. eceived b int d Name) C. D. Is delivery address different from Item 1 .
If YES, enter delivery address below:
❑ No
3, service Type
F Certified Maih ❑ Priority Mail Express'"
❑ Registered El Return Receipt for Merchandise
❑ Insured Mail ❑ Collect on Delivery
4. Restricted Delivery? (Extra Fee) ❑ Yes
le Number 7010 1060 0000 8476 8747
isfer from service label) —
m 3811, July 2013 Domestic Return Receipt
Mete items 1, 2, and 3. Also complete
4 if Restricted Delivery is desired.
dour name and address on the reverse
it we can return the card to you.
this card to the back of the mailpiece,
the front if space permits.
Addressed to:
jects LLC
'erkins Mill Road
;boro, NC 27530
A(InVature
� „❑ gent
C' l/ ddressee
B. R ived by (Printed Name) Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Maih ❑ Priority Mail Express"
❑ Registered ❑ Return Recei
n I— nor) nn�u M Cnllect on Del
4. Restricted Delivery? (Extra Fee)
eNu7fl1,0 1060 0000 8476 8778
sfer.from rom servibe )abet) 'it , r►, , _
n 3811, July 2013 Domestic Return} Receipt...,
C;jaits
MHCDO
Tyler Crumbley
LPO