65027D - Klutz

CAMA / --DREDGE& FILL
I
3 'ENERAL PERMIT
Mew EModification ElComplete Reissue
El Partial Reissue
Previous permit #
Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources �Jj.
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
4��Y
lesattached.
; u. KlRu4t- Project Location: CountyV q�o
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yes PNA yes C
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z permit may be reauired b;�r7i , Mki

DENR CAMA Daily Gneck Log Tor VNIKU
Date
Received
Check From (Name)
Name of Permit Holder
Vendor
Check
Number
Check
amount
Permit Number/Cof
11/25/2014 Backwater Marine Construction Inc. Klutz BUT 1731 $200.00 Klutz GP
11 et

I4; Division of Coastal Mgt.
3plicant:
ate:
Habitat Impact Computer Sheet
KI�Fi—t
Permit #: ( 5bzqt
=scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
dbitat 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 and/c
temp impact
amount
�l V
Dredge ❑ Fill ❑ Both ❑ Other
I
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 ❑
i2 1`4— I r C-1 C.-,Y

3 2014 3:07AM HP Fax page 2
NCDM
North Carof'ma [�partmettt of Environment and Neutral Resomm
D ywon of Coastal Mmapfnem
Be" Eam Perdue .tomes i{. Gre m Doe FrE
Gov ma C*OCW Sex
AGENT AVi.LHORiZATION FARM_
Date' 10 J'a -q- J I -
Nam& of Prcperfy for Pere* game of A I Agent for this PM ect:
Owner's bWMng Address.-
t `d' � 1(0
Phone Number
Agent's 1 aNng Address_
I �'i 0 % 1l i,P L...d. 4 icy
tone N (2LIV) i 3 - it ?Yk
1 certify that l have authorized the agent listed above to act on my behetf, for the purpose of applying
for and obtair*g ell CAMA Permits to it s.o or construct to following {activiM:
Property Owner

/AW

jo
17
abed Y21 dH WVLO.E Koz F

2014 3'05AM HP Fax
page 1
AWAG'TP'tT RIPAMAN PROPERTY OAR STATVWN T
(FORA PIERIItI[VMfVGPIXJNMY"17.tF"O+J700C O
l Aareby eadlf that I mD pmperty adjacent to .. L tit, s
(Nun of ref"tyOWW)
„any kcatcd at _
H-o 11 ied,etc)
on T (VS+attrpvdy) (town sin dfor Caun
AppltaauPs �,beat it: � '`� fE hWs g a ,uWf,*
Mc has dewnbcd lame. as st tam below,, dW dO*oP%WK iW.is pmPasing a► that ipcatiom, xad, I
havcno objcttioas to hia propgaai. t uridecstwrd timt epier/mooriag pi�rtp�.l bvHi!! 1 bod6ouss
mustbt.set back a minim m divance vf5item feet (15') horn. my Arta of ci minn *ccrss uttkKts
waived by ma. (i[yau �ii3h to w'>is"e the aetleadt. ion rn,rst iaitiel'ihe sppropt?at+e`blak
bataw)
_�.h ntrs wish to vweivc
wish to waivc. dot setback recta rttneet
/ ' ( 1>EKCkOI'i10N ATiwR D"WMG OF PROPOSED MVRXAWMgNTi
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