61505D - Anderson

CAMA / DREDGE & FILL -w 9 61
E N E RAL PERMIT Previous permit #
New ❑Modification _ Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 1 SA NCAC
❑ Rules attached.
t Name �W^; ; \ j A Yl{�(t�),.. f Project Location: County
w + l�V ��► ` (���CvJ1 tTOQ C1 Street Address/ State Road/ Lot #(s)I
StateNc._ZIP Z.:Z_ (lc. IviY'b} ��U 1 GVY t
(_ ) Fax # ( ) Subdivision W I fId l O kV-' Y Gt K-"'(-L.—
ed Agent
CW EW PTA _ ES PTS
OEA HHF - IH UBA - N/A
PWS: FC:
yes / no PNA yes / no Crit.Hab. yes / no
City i1t. � I Vi k. ZIP
i
Phone # River Basin ..tlI I
Adj. Wtr. Body 4;(1 f b\) Ti0 + K% V e ✓(r�
Closest Maj. Wtr. Body A I w I J
:)f Project/ Activity
(Scale: I V
lock) length
•m(s)
pier(s)_
length
umber
:ad/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards_
amp
>use/ Boatlift
Bulldozing
ti1:Z`l i ►/-i-3 E-I)
ne Length
not sure ye!
igs: not sure ye!
>rium: n/a ye!
ye!
Attached: yes
ling permit maybe required by: J1�U Y�S1^(1((C �� U11-�. ❑ See note on back regarding River Basin
I— .— _iil III/. r,,, l _ 1 1 J i

'; q=H2 From:
�`` Tos9429886
ce %94 Nab" Rewurces
mad F, Eafty.
b Aulhoirmetl AqW* GonM* Aqrewrm
is hereby authorized to ad
R Olrld!'ipf ('.� Psi nxWad
t#t� pfCp011y tasted b�fDMr The
a<1ttf0►rion
dm i C& Ed in the attached sketch_
LOCtATM OF PROJECT:
�v .S v plo v ,G r- v i f- C-6J C
PROMVV IM W MAA.Ui AUDFAM
i
Pwm IIOQ 9 lb get — z 3
.... PHONE NQ

1�645 �vmrhervit�•� �

/07/2004 19:20 9108429606 GREG HOLDEN PAGE 01
u
2�M& W OUT Y_i.1
.Name of Individual Applying For Permit:
Address -Of Property:
— pier v� uJ CjL
(Lot •or Strut , street ox and, C ty 6 County)
Y hareby certify that I om- property ad jacent try
raPerenced property- The indivlAval applying the above -
described to as as shown on the attached dirawfor this permit has
they are Proposing. Adescription or draw the development -
Should be provided with this latter.4 With dimensions,
I have no objections to this proposal.
uunsdarstand that a pier, dock, mooring Pilings, brae lift must be set back a wi.n akvater, boat
fro�a ay area of ripari&n access unless waived by distance of 15-
ta waive the setback, yqn (If you wish
below.) � initial the appropriate blank
I do wish to Waive the 15tsatback requirement.
I $Q_not wish to waive the 15tsetback requirement.
Vt.

/07/2004 19:20 9108429806 GREG HOLDEN PAGE 01
Name of Individual Applying For Permit: Gm Av%Je o�
Address -of Property: � � � S' S t
or Street street or Road, C ty 6 County}
I hereby certify that I ovn ro e
refere-nced property_ The individual tYadjacent to the Above-
applyingd"cribed to me as shown on the attached dr for this permit has
aw
they are proposing. Adescription or drawi � the development
should be provided with this letter.' with dlmensfons,
I have no objections to this proposal.
e
Div;,Kr..,.. � t 4 Dr*7DpSe�, nieeae iirT�tey the
(cement _ 1 77
r
I understand that a pier, dock, mooring pilings, braa)tvater, boat
house, lift lust be set back a minimua distance of 15•
from& my area of riparian access unless waived by me. to T.raive the setback, you (If Yeu wish
belcW.) aunt initial the appropriate blank
vi o-� viet L To s;5 s, T,.<'.5
i� I do wish to waive the 15tsatback requirement.
I dQ not wish to waive the 15'setback requirement.

ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
DISTURB TYPE
ibitat Name 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ RIX Both ❑ Other ❑
l 3 O
130
Dredge ❑ Fill Both ❑ Other ❑
0
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 ❑

J
J
J
s 1, 2, and 3. Also complete
,cted Delivery is desired.
name and address on the reverse
can return the card to you.
card to the back of the mailpiece,
front if space permits.
ressed to:
�t4
e„u ,
❑ Agent
❑ Addressee
eceived by (Printed N e C. Date of Delivery
7�i IN i� . '�C —)e-A
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type pp
v, _ I0 /� El Certified Mail ❑ Express Mail �
Si ❑ Registered ❑ Return Receipt for Merchandise
l � � ❑Insured Mail ElC.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
nber 7011 0110 �0�� 867� 5463
�m service label) ----_
11, February 2004 Domestic Return Receipt T625ss-o2-M-tsao
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