63995D - Parks

-1,CAMA / ❑ DREDGE & FILL - IL
GENERAL PERMIT Previous permit #
New AlModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized 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
❑ Rules attached.
it Name Co Lt AA t'� Project Location: County `f t Nr.�E /z_._—
-- � Street Address/ State Road/ Lot #(s)
(� ;N --State !JL ZIP 2_ csCY� 7J S �QP
Fax # ( ) Subdivision Vy Act! r►JE-Tod <.: c_
ted Agent N /^ City 4-\ i� IK i'� ZIP Z_�S
❑ CW 'Q EW Q PTA ❑ ES ❑ PTS Phone # River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. BodyEl
PWS: ❑ FC: rU ?� t
yes b no PNA -'y�yl no Crit.Hab. yes / no'��
Closest Maj. Wtr. Body 1
f Project/ Activity
a4 h-
ock) length /
��cs)
!ngt)"
tuber
d/ Riprap'll"ngth
g distance offshore
ix distance off ore
hannel
bic yards
np
IS. oatlift I x 2
ulldoz g
e Length i
not sure yes no
s: not sure yes no
ium: n/a yes no
I
yes no
kttached: yes \,041
f i ra 4 147k I A C j U
ve-r--e—�
(Scale:
ng permit may be required by: IV ;; ❑ See note on back regarding River Basin r

V� CAMA / DREDGE & FILL t E C E IVE D N? 6 T
ENERAL PERMIT JUL vi 4ermit #
ew JModification Complete Reissue Partial Reissue e vious permit issued
thorized by the State of North Carolina, Department of Environment and Natural Resources
ie Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
cant Name-_ i'� : � }' Project Location: County __�.i "YL-.• _
ess ] JV" 4 __ L� j ? '. j . Street Address/ State Road/ Lot #(s)_ 2
--- . d_KC—,ty — StateC-C_ZIP-c'�`.s=»
e # (` ) i Fax # { i _ _ _ . " _ - Subdivision .......... __....
prized Agent -- _ . -- - ._ - C��'—L.S --- ZIPS
ted Cw w TA ES __ PTS Phone # ( -" ZRiver Basin0 OEA D HHF N/A
s): IH uaa Adj. Wtr. Body .........1
yes PNA es Crit.Hab. yes no Closest Maj. Wtr. Body 5... .. ... ........ .....
SDy'N�------
of Project/ Activity
A -A, , A ' VAV .I -I PA nC 12/F-,O! --- U-A 1% 7

CAMA i DREDGE St FILL 63
GENERAL PERMIT Previous permit #
ew Modification Complete Reissue Partial Reissue Date previous permit issued
authorized by the State of North Carolina, Department of Environment and Natural Resources
I the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Project Location: Co unry--
dress Street Address/ State Road/ Lot #(s)
State ZIP'
me Subdivision I Kk--L,41t4
I 11C I ZIPZIOV41
City P
Cw *W LOrA -j as �M Phone # River Basin
acted OfA "M IN 0 USA "— WA
C(s): Pws� Adj. Wtr. Body--.--- 4
W. yes<a PNA yes CeA.114ab. yes Closest Mai. Wtr. Body —92f,42/1-
,pe of Project/ Activity Z415AI� QY114 I;PIAI�� 064,01K 14'
no, x cl;,Ver�Ln 6>0'k- kll,ft m n cl okc*-- �4- C>k^+rrvA (Scale:
isr (dock) kwW-,
In X I I
Wtform(s) 4W, 16 V
Inge' pier(s).
;roln Wngth
number
e .
ulkhee& Ftprap length_:
a ' rice offshom—i.
maLx dis e of Ishwe
alln. --hannv
cubic yards_
oat mrnp
x Tw
each
At,
t
4,
4
-4-
kv riot sure Yin
incoags. not sure Yes
Orexonum rVa
IV
ku.
Y.
Iowa:
Oa\w Am=wkk W5
building permit may be required by See note on back regarding River Basin rL
ote,f,/ Special Conditions elic-41
1,1d— A A 1 —.4 A—

I hZreby certify that I own property adjacent to Nytnct----be�op &m L-L�- 's
(Name Property -Owner)---
property located at L4+ lbewftln PA ti 7- / \
J (Address, Lot, Block, Road, qtc.) k
on H o rn t C r,.eA� I PVAJr N.C.
(WaUrbody) (City/Town incilor County)
The applicant has described to me, as shown below. the development proposed at the above location.
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)'
Sift` ck*qc�-re c7
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 )
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement,
(Property
Signalure J-06A
Print or Type Name
S101 lAW66*S
Mailing Address
Cilylstal;V71p,
Telephone Number
a 1 -91 - s)-t4—
(Adjacent Prop" Owner Information)
/7
Signature
Mym-4& D-sw�,, &A LLL C P-A CIL
Print or Type Name
Z114 eAC-111i0e f-,f-
Mailing Address
Lexiin4+0r-t , SL
cit)/Statelrf
( W03 49 60 --
Telephone Number
(Revised 6/1&2012)