63158D - Corbett

i� CAMA / [)� DREDGE &FILL �
9ENERAL 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_ �00_
� ❑Rules attached.
it Name - (jy' Project Location: Coun
I _ 1 ty_ TIOUK-S W'1(44-
+ Street Address/ State Ro d/ Lot #(s)
d, State( Zip—
b Wit) —?T? Fax # ( ) Subdivision N
:ed Agent ck2 + City 7U YA(A i�!u C1 ZIP ZS
❑ CW ❑ EW PTA '�ES C1'PTS Phone # (1 G j River Basin �, j�► i��
❑ OEA ❑ HHF J IH ❑ UBA ❑ N/A
El ❑FCc Adj. Wtr. Bodytti.(j� nat
Yes (no) PNA yes no Crit.Hab. yes //�o Closest Maj. Wtr. Body
' Project/ Activity
:k)length
igth
nber
1/ Riprap length
distance offshore
K distance offshor4
annel
is yards
P
e/ Boatlift
Ildozing
Length
`">>
not sure
yes no
not sure
yes o '
im: (n/a)
yes no
tached:
es no '
yes no
#(Scale:
permit may be required by: JGWh (y}- fh�t 4 (' fj ❑ See note on back regarding River Basin rul
—I 1 - -

�IWAZI x"16]4"7
NCDL 8375610
PH. 910-443-4829
P.O. BOX 1393
SHALLOTTE, NC 28459
PAY TO
OF
State Employees' Credit Union®
z % Supply, North Carolina
81
MEMO
es-no4/2531 1665
DATE-3 —21
$ aAO M
DOLLARS L� I„

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
pplicant: ��`,� �j��4G Permit #:
ate:
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
>und in your Habitat code sheet.
abitat 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
(�M
l Go O
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 ❑

14 1231p Tina Cook 910-579-3879 p.2
S i
NCDBAR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee free
Governor Director Secre
AGENT AUTHORIZATION FORM
Date:
dame of Property Owner Applying for Permit: Name of Authorized Agent For this project:
�R 1, co � � 0.vt (LouI
Dwner's Mailing Address:
q23 SI
-! )oSe - egc k , A)C -2-916,q
Phone Number 11) Z 1— 2119
Agent's Mailing Address
Phone N er f?/d 1 �q
1�4q - -wm
i certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CA10A Permits necessary to install or construct the following Cactivity):
(my property located) at 3 C d-,Lk Al -PIZA 0, YJ (L ` G Z ocl
This certification is valid thru (date)
•1
7-7 z� r
roperty Owner Signatle Date

14 12:31p Tina Conk 910-579-3879 p.3
e'ssi nano ands - F c�gy'w'rr' �OVPHbtY. 2UI0. *'
el
b OJ • � �V n p � .F
O _
o
T. Utngn, P.L. $C�'s L' 2 Can Drive
s'p °Oe ��/� ♦ tom,
�aaca�epO i ..
Existing Canal ►�
0
,Existin _ . _o .o.-fl° °�cx-moo° a a°-o °a ° -zr- o0
Bul hea o N 77*5326 E 50.01 011
_ Flogged LAMA Nc me
Nigh Woter Line
Tap of Slope
Lot D — Blk 15R IQto Lot 2 -- BIk 15R
N
O
5565.3 SQ. r T".
3t)_CAMA Buffer r o
r Setback Line t-"
I I
J I
m
(niOD
I
Existing
House -, o I a �
co ( w
r I j
I v3 �o
i 1
orb c4} p L_-_______-
25' Setbock
F pro Pro per y OT
20Q.00' 50.00' 359.83'
S 79`00'00" W 609.83 Total
Canal Drive - 403 RIW -- F'ublic

14 12:32p Tina Cook 910-579�$79
. '; p.4
Items 1. z, and 3. Also w., fete
ieMoted Dolivery is desired.
A. sigWurie
ElAgent
name and address on the revere
X h _ A q
- A
1� Addw.
e call return the carts to you.
s card to the back of the malplece,
G.
a. Recetved by Prfnted Nam } Date of Delivery
front if space permits.
��� r�� i
D, s deivon address dSffaent�m item 17 M Yes
—
ressed to:
if YES, enter dslivrey address below. E3 No
PWe 1llF �'
110-Ili jjVCL
f
3 S icaType
10 Ceffed MaIP ❑ Priority LUM 6agees'
13 Registered 13 Ptmn Reodpt for AAerchandise
© insured Mail 0 Colect on DeTtrery
4 Restricted DT*my? extra Fee) ❑ yes
ibex m SGWkG saw 7013 1710 0000 3332 1837
11, July 2013. DomBsfc Return %oeipt
items 1, 2, and 3. Also complete
A signatures:
estrlcted Delivery is desired
x ; . i 11 Agent
name and address on the reverse
Nrhddzessee
Carl return the card to you.
card to the back of the rnaipieca
S. fieceK6&by nrnc�e}
! -, j/
c. to of very
rent if space pen'r t .
l l
assed ta:
D. 's deEvery a3dress rM'ViWtn 1 © Yes
!fY6, enter del'•-
'ss5-�e
(
l it
t f
a S rvice Type
rerftd Mai Q riority Mali EA
M Rogistered 'tempt for MordmIdiss
Cl Insured Mall Cl Collect on DaMmy
k Reski ,Ed DdivwW akfra Fee) i7 Yes
ry ,abd} 7013 1710 0000 3332 1820
1, My 2013 Domestic Rehrn Receipt
.

14