63105D - Bunker

63
LAMA / 'DREDGE & FILL P� tip'
IENERAL PERMIT Previous permit # N /�
New -Modification ❑Complete Reissue El Partial Reissue Date previous permit issued�j
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ' Zno
❑ Rules attached.
Name�kR i jLl� 1�-ii LA°t 'Project Location: CountyEJ+e__.
Street Address/ State Road/ Lot #(s)
State / ZIP___,
"0 Fax # ( ) Subdivision
A Agent City � < � � ZIP 7d`� ��
❑ CW ❑ EW PTA ❑ ES ❑ PTS Phone # ( River Basin CfX
OEA L_l HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 15el L z C 441 M Pt n
❑ PWS: ❑ FC:
,es ,!� 'PNA yes no Crit.Hab. yes / go Closest Maj. Wtr. Body
Project/ Activity I�
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w(s)
gth
fiber
I Nprap length
distanc ore
distance offsllpr
innel
c yards
P
e/ Boatlift
Length ' L` .1'
not sure yes ,' n
not sure yes n
im: n/a yes n
yes JU[[ached: yes
(Scale: (ri_
g permit may be required by: 0L/ 4f f c-(A*
El See note on back regarding River Basin ru
(Scale: (ri_
g permit may be required by: 0L/ 4f f c-(A*
El See note on back regarding River Basin ru

implete items 1, 2, and 3. Also complete
m 4 if Restricted Delivery is desired.
Int your name and address on the reverse
that we can return the card to you.
%ch this card to the back of the mailpiece,
on the front if space permits.
A. K,e ' ❑ Agent
X El Addressee
B. Received by ( rioted Name) C. Date of Delivery
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icle Addressed to:
D. Is delivery address different from item 1? ❑ Yes
If YES_ enter delivery .- 0 Nn

Division of Coastal Mgt. Habitat Impact Computer Sheet
J'
)licant: 811dloyd Pollook Permit #:
:e: I ) ) 4
>cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat 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 andh
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other<--
�6
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 ❑

Division of Coastal Mgt. Habitat Impact Computer Sheet
r
plicant: -6,j,tr� �111
LLC' V� Permit #:
te: � / / �
H
Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen,
nd in your Habitat code sheet.
Atat 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 fine
disturbance.
Excludes any
restoration and/
temp impact
amount
00
Dredge ❑ Fill ❑ Both ❑ Other )0,
q/
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 ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I"
I hereby certify that I own property adjacent to &vA%, I t � ( l L ) C' 'q, 1 - f y
8,
Name of Property Owner
property located at 703 A�+ `�O( l� • 1��e�-fir, �F � �I
Address, Lot Block, Road, etc.)
on , s �p Ca�� - in fio `►1 Ex" a► k R4&- QD• N.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above I
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 dray
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be se
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish i
the setback, you 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 Information) (Adjacent Property Owner Information)
gignature i ature
�tint or Type Name Print or Type Name
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Building Permit Application
Town of Topsail Beach
820 S. Anderson Blvd.
Topsail Beach, NC 28445
Phone: [phone] Fax: [phone]
Date: Proiect Address: !"3 4v18goynd.e.,-sue 131�d
Property Owner
Mailing Address
Signature
Applicant
General Contractor
Mailing Address
Telephone #
Signature
Electrical Contractor
Mailing Address
Telephone #
Signature
Mechanical Contractor
Mailing Address _
7J,_,)n w 41 11) 1- . L . F � �s7 c - 8rej(e-, r ic�5e
Phone# ctt0'�`t��- Oyo�-
State License#
Privilege License#
State License#
Privilege License#

Plumbing Contractor
Mailing Address
Telephone#
Signature
Insulation Contractor
Mailing Address
Telephone#
Signature
Gas Piping/Other
Mailing Address
Telephone#
Signature
# of Bathrooms
State License#
Privilege License#
State License#
Privilege License#
State License#
Privilege License#
Square Footage Heated Unheated
Estimated Project Cost
Description of Work
add-Z-Y?f� A, t� ` $'-�l.m.4�g a-r, C�L --tr,
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