62625D - Breeden

CAMA f DREDGE & FILL
Ci,'31.r.
E N E RAL
PERMIT
v 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
Fi
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
V -
XRules attached.
nt Name_ 1,4 V I a
Project Location: County
Street Address/ State Roa�d/� Lot #(s)
_ jamV)VY
_ StateK_ ZIP ZS� ()
( )_' ;
Fax # ( )
Subdivision
(,(
ized Agent `i1y`
`_ L
fr J�1 g fl k�,( SV A UT1 tf,,-i,,,.;
City ZIP7aql
❑ CW XEW
PTA ❑ ES ❑ PTS
Phone # (/) tY t �7 j River Basin
d
❑ OEA ❑ HHF
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Bod(nat
❑ PWS:
❑FC:
'-
yes / ono PNA
l
yes / no Crit.Hab. yes / C/
Closest Maj. Wtr. Body
�d Project/ Activity CA gwlt y d V4 J IulAu n s -6 {
lock)
n �, v v (Scale: 1 ��.
pier(s)
length
umber
!ad/ Ripraplength
vg distance offshore
nax distance offshore
channel
ubic yards
imp
use/ Boatlift
Ildozing
ne Length
not sure yes no
cgs: not s yes no
>rium: n/a no
S
no
Attached: ves (ne
ling permit may be requires
i e..e..:. l r,...a:�:....�

Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Found in your Habitat code sheet.
-labitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tempimpacts)
FINAL Sq. Ft. TOTAL Feet FINAL Feet
(Anticipated final (Applied for. (Anticipated final
disturbance. Disturbance disturbance.
Excludes any total includes Excludes any
restoration any anticipated restoration and/o
and/or temp restoration or temp impact
impact amount) temp impacts) amount)
l
Ov"
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

101
66-30/531
865
Date
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ink
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
fuel F. Easley, Govemor James H. Gregson, Director
William G. Ross Jr., S
Authorized Agent Consent Agreement
�...0. f ��► �, CG Q' +- is- hereby authorized to act on my beh
-i— (Printed Name of Agent)
der to obtain any CAMA permit(s) required for the property listed below. - The authorization is limited tc
:ific activities described in the attached sketch.
:ATION OF PROJECT:
:eco Ts le, �&ad,
r� day 6q
�PERTY OWNER MAILING ADDRESS:
Snaky is
HORIZED AGENT MAILING ADDRESS:
ature of Property Owner.
PHONE NO., q 1C) '-75 q qoq 4 1
7%.,- eee.d '5, "d"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Dpy od 'B�e n is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
$W t Cry, N.C.
n� Canal a�E'
on t��0►.f1�'�G Ini�CCDCbQ IAJcs?Z(0 in (V
(Waterbody) (Town and/oe County)
Applicant's phone #: qlD 9160 b5gB Mailing Address: 161311 Snake 5i
Lavr.-,Aura OC,
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
F e SK6d\
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
U Rl �I�s� Dr,
Mailing Addre
(Riparian Property Owner Information)
Signature
►1 n non •���

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to f)0.V od'8(VJeAe-n is
(Name of Property Owner)
property located at C06� arA 5- ,
(Lot, Block, Road, etc.)
on In+clCa[.6iul IAkLTef oalin ftiJ $l� t Cry, N.C.
(Waterbody) (Town and/d County)
Applicant's phone #: U c9eO bSaB Mailing Address: ► AI Snnle 5�
Lowr;,abvra 4C,
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
F E aAA�ad*-A S Ke kc1h
(Information for Property Owner Applying
for Permit)
Ta e-5% e-
Dr,
Mailing Addre
(Riparian Property Owner Information)
�, �V" � - " �11 t -t .'� -,
\IJ ` ' ` Signature
\ n\.. _ IL _ H s_ ._ A