62687D - Gallins

'CAMA / ❑ DREDGE & FILL Ql*/4 A4 <'?3?
x"EN ERAL PERMIT 4 Previous permit #
'New J Modification ❑ Complete Reissue ❑ 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 I SA NCAC
' Rules attached.
Name Project Location: County
iOLD
Street Address/ State Road/ Lot #(s) JA
`l ,- State N�C, ZIP
Fax # O Subdivision 1A`
Agent 1 Q A (,(! _ �r City ' ZIP
❑ CW �EW �TA El ES ❑ PTS h ? ' r River Basin
ElOEA ❑ HHF "❑ IH ❑ UBA ❑ N/A y A iAQ` ►L[ t WO
Adj.. Wtr. Bod � -ST� AI
n
❑ PWS: ❑ FC:
des no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Project/ Activity
:k)
(Scale: ! //
igth
nber
I/ RipToffshor
distK disanne. .
iic yards 4_
ip rr
W Boatlift J %�
no
attached: (yes> J.
ig permit may be required by (� �a {1 l �(I (.��/ ❑ See note on back regarding River Basin i
- - - - -- - ' _ 11 (Inn f. .- ,I ! t I I 1 ". r I C71 - I . ... .I I I ,

BACKWATER MARINE CONSTRUCTION INC
1907 KIRBY RD BS. [phone]
SUPPLY, NC 28462
Pay to the
Order of
1429
66-112/531
Date
�Ji 4f \ Dollars
Beck.II III
BRANCH BANKING AND TRUST COMPANY V F[ q
14M-BANK BBT BBT.com
q �I
For— ;!i �o G a., M,
l:0 5 3 10 1 1 2 0:000 5 109 2 2 19 4 ?00 14 29

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: r' I , 'n Q ' Permit #: G
Date:
l
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurem,
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 Feel
(Anticipated I
disturbance.
Excludes any
restoration ar
temp impact
amount
4
Dredge ❑ Fill [IBoth ❑ Other
0
6
Dredge ❑ Fill ❑ Both ❑ Other
9 3
Z b
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 El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

lin
-�

24/2014 09:05 FAX �� ��02
w.�
R
North Carolina Department of Erivironment and Natural Resources
Divisbri of Coastat Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governs' Director _�
AQENT AUTHt)RtZA110N FORM
Date: ho
+lame of property Owner Applying for Permit Name of Authorized Agent for this project:
Owner's Mailing Address: /
-bJ --
Phone.Number fH61,_7
Agent's Mailing Address: f
r 4{J
r
Phones Number` 8
2-
I rertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and attaining ail LAMAPermits necessary to install or construct the toll wing (alctivity)'
`
(my property located) at
This certification is valid thru (date) 201 _
property owner Signature Date

24%2014 09:05 FAX R003
+ { TT RN RFCEi�T R +, TEU j e�6 r i
• CERTIFIED MAIL=,
I)1VIS'ION OF COASTAL MA-NAGFME`iT
ADJACENT RIPARI,AIN PR.OrERT'Y_ pwnR STA'TFMEINT
Z
Name of Property Owner: n�i � �� ��•� ��:^ S �— --: — —.
Address of PropertY: f__._
('Lot or $tract 9, Street or Road, City & County)
Applicant's phony
Mailing Address:
- O Cl
l- tar
ec+ent to the above referenced property. The individual applying fOr this pe
I hereby certify that I own property adjrm has described to me as shown on the Attached drawing the development they are proposing. desc ' lion wi
i - •ons •ist bg ar_GV1S1;—dW—ette[-,
I have no objections to this proposal. — I have objcctiotis to this proposal.
If you have objections to what is being proposed, you Mwt notify the Division of Coastal Management MCM
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive E:
Wilmington, NC 28405-3$45. DCM representatives Cana also be contacted at [phone]. No response is
cotsidared the *me age objection if you have eeR #otified b Certitfed Msil•
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift most be set back a minimum distance
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you mast initial the
ap Qfpate blank below.)
I do wish to waive the 15' set back requirement
I do not wish to waive the 15' set back requirement.
(property Owner Inforntatioa) (Ripam rh property Owner Information)
__ _r._-- -- Signature.
Signature
Print OrType Name
Mailing Address
W,,,5 L,, _AlC. 29)0`J.
City / State / zip Telephone Number L`t
0 r - ©1 O
Print or Type Name
- -, � tl� � - (� �,A�l -
Mailing Address
city 1 state 1 zip
Telephone Number
bate /, a '`
1 -) n, if/

Cl?arIFIED MAIL, - �T WN I&
ICEIPT REQUESTED
DIVISION OF COASTAL' iiNAGr1,N FkN l'
ADJACENT RIPARIAN, PROPERTY. OWNER STATEI.MLNT
Name of property Owner:) ? L
Address of Property: .......i' �? n r �t 5 �
(Lot or Street If, Street or road, City & County)
Applicant's phone #. 1y�G� i J" AlIailing Address;
_Ay_`�:.� F `"` - -` .... .y7 (G
t hereby certify that l own property adjacent to the above referenced property. The individual applying for till
has described to me as shown on the attached drawing the dcvelopraent they are proposing. dvscFiptintt. cif t
yviaL in nsiorl� _ 11 t br• proy_icigd wjtt► this letter.
r,9 t have no objections to this proposal. - I have objections to this proposal.
if you have objections to what is being proposed, you nimt, notify the Division of Coastal ManaAeulent .
in wrftiag within 10 slays of receipt of this notice. Correspondence should be mailed to 127 Cardinal Di
Wilmington, NC 28405-3845. DCM representntive_s can Rise be contacted at [phone]. No respos
0 sztiered the same as no ob& ion if You have, been notsc la!Qertitied Mail.
WAIVER SECTION
I understand that a pier, clack, mooring pilings, bteakwater, boathouse, or tilt must be set back a minimum. di:
IS' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must i:nitia
apprUnriate blank below.)
'1�. I do wish to waive the 15' setback requirement.
I do not wish to waive the l5' set back requirement.
(Property ()weer Inforimation)
Signature
11 J.� ff
Print or Type Name
Mailing Address
City I State I :Gip
(Piparian Property 'Owner Inforntstio'
,/
Signature
j_
Print or Type Name.
fo
Mailing Address .T
City I Stato I Zip
Telenlx)no Number --