63182D - Sasser

�( 63a
LAMA / ,❑ DREDGE & FILL Q 0
iENERAL PERMIT `�'
Previous permit # d
14ew ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources 4 ,/" UG
)astal Resources Commission in an area of environmental concern pursuant to i SA NCAC iJ D Rules attached.
Name
✓ State N c ZIP'9 tf S
7 �'Fax #
A Agent )o
❑ CW 16�,EW % PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes /( "tf"b1, PNA yes / (!D Crit.Hab. yes / nb
Project/ Activity �^
:k) length
1(s)
i s)
ngth
tuber
d/ Riprap le h
g distance offshdr
ix distance offshc
hannel
bic yards
mp t
u Boatli (�
3ulldozing
ne Length t'_
not sure
gs: not sure
)rium: n/a
Attached:
ling permit mad
Project Location: County ^/yt' ��--
Street Address/ State Road/ Lot #(s)
5c,x;-3 ► A S{- .
Subdivision
City v,( C'rm ZIP
Phone # ( `—�River Basin C�
Adj. Wtr. Body � ✓+'� �-�cu �clj- �/(�nazt)kClosest Maj. Wtr. Body
(Scale: I It
=e

PAY
TO THE
ORDER OF
NATURES OWN LAND CO.
1216 N TOPSAIL DR
SURF CITY NC 28445-6740
C�ENlz
BankofAmerica''I
ACH R/T�053000196
FORQom-
2797
66-19/530 NC
56754
DATE SKY
$2©o0_
s.�or°�^,�y
DOLL ` o;'

Division of Coastal Mgt. }habitat impact Computer Sheet
licant: Pla✓` Ir i Sk SCA-SS CA- Permit #
I2'lj ((V
�'3 [gz- -(
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
iitat 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 I
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fina'
disturbance.
Excludes any
restoration and/(
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ElOt::[E:ll
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 0 Both ❑ Other 0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ��72Q(S/I 5;" s5tA— 's
( (Name of Property Owner)
property located at 30�3 � ��'l. S
ad
/� ' _ (Address, Lot, Block, R , etc.
on ( 4 in �l2F C t /�� �G �i.J N.C.
(Waterbody) (CitylTown and/or 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)
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.)
M A 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr e O er Information)
7
i nature
Print or Type Name
Mailing Address „ c„f,
(Adjacent Pr/foperty Owner Information)
SiMature
Print or Type Name
i°7 (-,1"Ehf'(✓Ln LG✓1 t_
MaIWV Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
(Name of Property Owner)
7-S r-C1(--7/vZ
I
(Address, Lot, Block, Road,etc.),�9 9j����,��%on 04V4 t in : r&(L- r �I f/ /VC )Sk(" c.
(Waterbody) (City/Town' and/or 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)
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.)
(P
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
Print or Type Name
ld /( A,).
Mnilinn drlrlrnoc
(Adjacent Property Owner Information
Yd
Signature
Print or Type Name
;? rd Ja
Mnilinn drlrlrnec

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