63183D - Bousquet

� CAMA / L DREDGE 8c FILL Q ` a ��
3hENERAL PERMIT Previous permit #
INew Modification El Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources b� ' Z.y U
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
�I,� ' Rules attached.
t Name > t 1 S U Project Location: County �1 b"'J
T� Street Address/ State Road/ Lot Q#(s)
ikw5o J V I{ ).t StateN G- ZIP �?/
Fax # ( ) Subdivisio LA l tea_
:ed Agent li%, 5 ?"4Z'yr City V �'C IP csi1,
❑ CW D EW PTA ❑ ES ❑ PTS Phone # ( ) River Basin LA" f J
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
El PWS: ❑FC:
yes PNA dies / no Crit.Hab. yes / Closest Maj. Wtr. Body
Project/ Activity Nc �11 1 fib rY` i"
ck)length 0
ngth
mber
d/ Riprap length
distance offshore
uc distance offshore
cannel
Dic yards_
np
ise/ Boatlift
e Length `s
not sure yes yrt0�
s: not sure yes n
ium: n/a yes o
yes " n
4ttached: A 1 no-1
)r
(Scale: ' : �
ng permit may be required by: ,JC/J(/( (.j,_-t ❑ See note on back regarding River Basin r

COASTAL DREDGING, LLC
2075 Hwy 172
P.O. Box 295
Snends Ferry, NC 28460
910-327-8831
PAY TO THE /V C N
ORDER OF
3402
y
�vV+Oa
c
DOLLARS 8
MEMO Gt one
AUT R SIGNATURE ._._._
115003402112 i:0 5 3 L❑ i L 2 w.snnn S inp. 1; PA :iAw II
BB&T
BRANCH BANKING AND TRUST COMPANY
1.800-BANK BBT BBT.com
66-112/531

MC Division of Coastal Mgt. Habitat impact Computer Sheet
applicant:
)ate:
OV��rJ�
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
ound in your Habitat code sheet.
iabitat 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 fi
disturbance.
Excludes any
restoration an
temp impact
amount)
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 ❑ Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
overly Eaves Perdue Braxton C. Davis
)vernor Director
Dee Freem�
Secreta
AGENT AUTHORIZATION FORM
Date: {y
ne of Property Owner Applying for Permit: Name of Authorized Agent for this project: f
.6 X,,v6&,,4 —eavS c7yE/ ,� — d��i �'�<O,:7
ier's Mailing Address:
LGK So v IJ.�LLE iv C
�sy �
ne Number (yi v)
Agent's Mailing Address:
po b©k C2 cyS
� oyLJY 10/ <7
Phone Number -- 760y
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
nd obtaining all CAMA Permits necessary to install or construct the following (activity):
a 4i /.>yG k
my property located at / .3 9 Z of 6vti%Q tW y D/,JVE .3-4C/CS.�vti�l �` A✓C
certification is valid thru (date) 1
Property 0 r Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: '6y"'Ral
Address of Property: 13 7- Z A 61,.vA .9,4y Q 1U'V 3sCRG�Sa.'vttr-;� LE _N v2
(Lot or Street #, Street or Road, City & County)
Applicant phone#('' Mailing Address: !� tJ g0 'C.��
34Ck S✓,•V$ZZG .vG ),rS i /
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
ft-/Ii� I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
v� ive the setback, you must initial the appropriate blank below.)
/[(// C I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
nature
Print or Type Name
(Riparian Pr©p rt Owner Information)
Signature
<\_ k\ � A L
Print or Type Name
Mailing Address
Mailing Addres

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner: AV4,,, -6 XiUF;6C.,4 e�vSPvl-l-
Address of Property: -:Z3y L.4GUti4 QAY D2UUE SscKS-vl/,LCf ✓VC Z.P.,
(Lot or Street #, Street or Road, City & County)
Applicant phone #: (2/ o) SyS -.172 J Mailing Address: P 0 _gz;>� 5y.
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
15� I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.)
S_ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
l
nature
Print or Type Name
P� Rq nd �'
Print or Type Name
Information)
P 0 l? a x vs
Mailing Address
Pu bj'� lc�
Mailing Address

f
09 x