63272D - Gordon

tWA DREDGE & FILL
GENERAL PERMIT Previous permit #
New Modification Ll Complete Reissue Li Partial Reissue Date previous permit issued
ized 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
N?Rules attached.
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DENR CA MA Daily Check Log for WIRO
Date
Check
Received
Check From Name
Name of Permit Holder
Vendor
Number
Check amount
Permit Number7COmi
8/25/2014
Bearing Point Consulting
To sail Reef Condos HOA
Postal Money Order
21814097771
$100.00
mod, fee, MP 39-12
8/25/2014
Steven and Robin Farmer
John Crooks
BB&T
7060
$200.00
GP 64001 D
8/25/2014
Vamams Docks & Bulkheads
Deborah Libucki
BUT
6902
$400.00
GP 64000D
8/25/2014
Clements Marine Construction Inc
Vern Hawkins
First Citizens
3546
$200.00
GP 64040D
8/26/2014
F and S Marine Construction
Lookout Harbour HOA Tom Hanna
PNC Bank
3955
$100.00
mod. Fee, MP 66-10
8/27/2014
Charles F. Riggs & Associates Inc.
Lot 13 The Peninsula OTopsail
First Citizens
13599
$100.00
minor fee, Living Coastal
8/27/2014
Charles F. Riggs & Associates Inc.
Frank Vick
First Citizens
13601
$100.00
minor fee, 507 S Shore [
8/27/2014
Antinori Construction Inc.
Bob Julian
B of A
3137
$200.00
GP 63930D
8/27/2014
Connaway Marine Construction Inc
Robert Parks
B of A
6822
$200.00
GP 64029D
8/2812014
Allied Marine Contractors LLC
James Gordon
B of A
6770
$200.00
GP 63272D

G Division of Coastal Mgt. Habitat Impact Computer Sheep,
plicant: y� Permit #: �.
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
ind in your Habitat code sheet.
bitat 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,l
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp im acts
FINAL Feet
(Anticipated fin;
disturbance.
Excludes any
restoration ands
temp impact
amount
/
V
Dredge El Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other AQZ��
Z
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 ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
::��Iby-
Name of Property Owner Applying for Permit:
�g&?&S E
,ddt�
Mailing Address:
CL�Y
I certify that I have authorized (agent) I���;Gd xo--Z6.Q "Ik4 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 6m<5 90rd0rt s
(Nalne of Property Owner)
property located at
(Address, Lot, Block, Road, etc.) /
on , in ljl�� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to tion.
�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 rill in description below or attach a site drawing)
5ec a#0 aal
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
C I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
/ LP.coperty Owner Information) (Adjacent Property Owner Information)
S' ature Signature
ZTy
Pr f r jy a Name Print or Type Name

013
o a C)
c Se
I
� a Q-7�
a

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to lay <5 �;ordorL I
(Name of Property Owner)
property located at
on -)r6AJ
(Waterbody)
(Address, Lot, Block, Ro Td, etc.)
in i`%Z, .�S%� N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I ti n.
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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 towaive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
St nature
a4&
Print, or Type Name _
(Adjacent Property Owner Information)
Signature
Print or T pe Name