60685D - Gallins

Y CAMA / '- DREDGE & FILL
GENERAL PERMIT
New AModification E (Complete Reissue 1Partial Reissue
orized 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
ized Agent
d ❑ CW
C OEA
❑ PWS:
yesl
State ZIP
W APTA 7 ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
J PNA ye / no Crit.Hab. yes no
A Project/ Activity
ock)length
pier(s)
ength
umber
ad/ Riprap length
vg distance offshore
iax distance offshore
:hannel
ibic yards_
Lmp
'use/ Boatlift
No. 60
Previous permit #
Date previous permit issued_
ules attached.
Project Location: County t1 1Vfin/ 1 U
Street Address/ State Road/ Lot #(s) (�
t: r
Subdivision 4 W
Cii'Q1u�,l�ti �c� ZIP
rmone # River Basin
Adj. Wtr. Body ' � /J nat
Closest Maj. Wtr. Body
VW
Ili�. 11 I� 1' 7i/••
1
sfl
4,
(Scale:
3 Ildozin
tt
ne Length S - — -
not sure yes E-O
gs: not sure yes
c
rium: n/a yes n X +
I
yes no t✓� -
Attached: yes no
ling permit maybe required by:1 I r ,W►i J Cl al-1 1<j �❑ See note on back regarding River Basin

BACKWATER MARINE CONSTRUCTION INC 1434
1907 KIRBY RD BS. [phone] 66-112/531
SUPPLY, NC 28462
Z
� Date
Pay to the
Order of _
BRANCH BANKING AND TRUST COMP �1S� A
14800-BANK BST BBT.com L(.\J
ForR 4
$ 26o z%
Dollars

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Permit #:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
found in your Habitat code sheet.
Habitat 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)
V AA
Dredge ❑ Fill ❑ Both ❑ Other
6
V
Dredge ❑ Fill ❑ Both ❑ Other
h�j
l7
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 ❑

B/2014 09:10 FAX IQJaa2
North Carolina Department of EnvifoArrent and Natural Resources
Division of Coastal Management Doe Freema
eaverly Eaves Perdue ,lames ti. G*sm Secretai
Governor
plmctor
AGENT AUTHaRIZ6TION F RM
Date: 1
for Permit: Name of Authorized Agent for this project:
Name of Proper% Ow er Applying
owner's Mailing Address:
A__-
Phone Number d3' �O�—,bo— YZ
Agen�t'ss Mailing Address:
Phone Number
purpose of applying
certify that 1 t1ave authorized the agent listed above to act on my behalf, for the p
for and obtaining all CAMA permits necessary to install or construct the following (activity):
(my property
located) at
This rertifiaation is valid thru (date) —
Date
Property owner Signature

28,'2014 09:10 FAX f1003
CERTIFIED VWL - RETUM RECE= BEQUESTED
DIVISION OF COASTAL IMANAGEMENT
ADJACENT RIPARiAIN PROPERTY, OWNER STATUYIENT
Name of property Owncr: �c. � �i��� —la u � U�nS -- - ---------� -
Address of Property: _ P?fl _► n U--
(Lot or Street #, Street or Road, City & County)
Applicant's phone 4. g --- Mailing Address: �e7. _ 1,4 , L P �
?.set... -
I hereby certify that f own property adjacent to the above referenced property, The individual applying for this permit
has described to me as shown on the attacbad drawing the development they are proposing. A dcscJpflo� Qf tira�r�,
with dirfie—m-sions. mast be pruvidod,letter
-�*f havo no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you moat notify the Division of Coastal Mauggement (DC"
in writing within 10 days of receipt of tkis notice. Correspondexce should be melled to 127 Cardin9l Drive Ext.
Wiimiugtoo, NC 28405-3845. DCM representatives can slso be contacted at [phone]. No response is
c9plidererl the came as no obiecaun if you have been notified by Certified bail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
15' from racy ama of riparian access unless waived by me. (If you wish to waive the setback, you mwt initial the
appropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requiremeut.
(Pro'p�erit�y`Owner Information)
Signature
rn� .1I,�s
Print or Type Name
IUqz-atfW po J C r e�e k
Mailing Address
Wiis�'i 50,\ePI_.1
City / State / Zip
Telephone Number %Y�`�
Date
a
--
Print or Type Name
�dcl a 1"t L Q r�Qia nit �p,r-m c fc
Mailing Address
iUC_.�lCy� _.
City / State / Zip
Telephone Number r
Date / _ .

?8/2014 09:11 FAX
Z 004
mplete items ?, 2, and 3. Also complete
m 4 9 Restrlctad Delivery is desired,
ant your name and address on the reverse
that we can return the card to yau.
tach this card to the back of the maliplece,
on the front if space permits
ticie Addressed to:
A fiignature
.r fin
B. Recelved by (Printed Nano;
D Agent
r7. Date of DBINery
r) n t . Ir 1
? ❑ Yes
D. is delwery addmg9 dlQerent ircxn iten, t
1f YES, enter delivery address Mow, ❑ No
3_ qbp0t6G TYPO
in Certified Mail 11 5xixass Mau
0 Registered a RetUm Rewip[ rnrMBrCh3htii80
0 insured Mail 0
4, ReslriclAd beltvery? i�xtra Peet p �`� _
lrticlo Number 7 013 1090 0001 2548 1-4 8 4 9
Transfar fmm servJce la.,,,•j — iat5W-024A-9 A0
February pomeatic t�Ctum i�ecCit)t
Form 3811, ry 2004

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