62537D - Baker

-'CAMA P DREDGE & FILL
GENERAL PERMIT Previous permit #
'New Modification Complete Reissue L1Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources / 7 U
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC U
*j��❑ ules attached.
il
nt Name � % Project Location: County & �' L✓ 4�;- .
s y. Street Address/ State Road/ Lot #(s)
State Ll
# (^_)TFax # O Subdivispn
ized Agent ��City ! ZIP�f
d CW EW XPTA ❑ ES ❑ PTS Phone # ( ) River Basin
OEA HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Bod �4�C - nat
PWS ❑FC:
yes / no PNA yes /not C/rit.Hab. yes r% no^;
Closest Maj. Wtr. Body
A Project/ Activity A
(Scale:
�ock) length
length
umber
ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp +� ^�
iu Boatlift L � � G
Bulldozing__
ne Length
not sure yes no
gs: not sure yes no
mum: n/a yes no
yes no
' Attached: yes no
ling permit may be requirec

c
Permit #:
ate:
13
!scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
)itat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑
Fill ❑ Both ❑ O
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 0
Fill ❑ Both ❑
Other ❑

B. BAKER, JR.
66-7704/2531 , 9175
M. BAKER l
WARIX CT
. BEACH, NC 28460 L�
'Credit Unionm
ks vi .Nguh Carolina
r
:0863223630911■ 9175

24 13 '03:25p
7/24/2013 WED 12.03 PAX 910 327 2035 TREASURE REALTY
ADJACENT RIPARIAN PROPERTY OYYKRSTATEMENT
I hereby certffy that I own properly adjacent to �-Qy— •g
�Na o71P roRerty Owner}
property located at _ d 7 OJT , ►r �L . O11t1 f
on
(Waterbody)
(Address,
, in
Block, Road, etc.
(City/Town and/or County)
N.G.
F
0001/001
The applicant has described to me, as shown below, the development proposed at the above location.
I have no ob)echun to this proposal.
I have ob)eclions to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPM!~NT
(individual proposing development must fill In descrfptlon Aelow or attach 9 Slte drawing)
S fO5 :.. ' ?
® /
WAIVER $F—cTLN
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.)
xV� I
� t do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner I formation)
Si lu e
Pri f or T e ppre
Mar tg Adesfi 1
City 18te/Zrp
—��'— j
Te/e ho a Nu ber
ation)
Sivature f
ri-f S. 57�Vcw✓5
Pr1nt or Type Name ffzaRrivrtc �0 T�A� s
4�201 NG SIG hl I o� q t gT2t
Marling Address
�A u c, 27s7
CrtylStatefLlp � 1 � � b� ?7� �o /
Telephone Number

)/2013 08:06 FAX 1+919+772+5810 John D.Adams & Co. IA00031
/2013 FRI 16:40 FAX [phone] TREASURE REALTY �Ot
n 911 7
I hereby certify that I own property adjacent to � Q, 9 Lev s
a e f Prope Owne )
property located at a f'
(Address, Lot; Block, Ro d, etc.)
on , In
(Waterbody) (C(ty/Town and/or County) N.C.
The applicarit has described to me, as shown below, the development proposed at the above location.
t have no objection to this rt� orsal.
1 P P
I have objections to this proposal.
DESCRiP.TION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in descrlptfon below or attach a site drawing)
J
I�IIa1VER 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 epprapriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Info tion) (Adjacent Property Owner Information)
Si nature
Print or Type Name
.L,r& I. a IV L 5y M t,J yam_
�M iling Address
Sf nr tJ to r N e._
City/StA1e/zip — - r __ .