62565D - Cook

CAMA J O DREDGE & FILL
GENERAL PERMIT
Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
:gRules attached.
It Name
Project Location: County �jr'�j" `� 01146K�
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Street Address/ State Road/ Lot #(s)
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F it- r State L., ZIP2-9-1 S
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Subdivision
:ed Agent t` { t k wkf r' iAoLl ¢U ilk
ZIP �C
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❑CW ❑EW ❑PTA tES ❑PTS
Phone# l% )�1 ! River Basin
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
Adj. Wtr. Body (nat
❑ PWS: ❑ FC:
l
yes / no PNA yes / no Crit.Hab. yes / no `
Closest Maj. Wtr. Body
f Project/ Activity
ick) length
mgth
tuber
d/ Riprap length i
g distance offshore
ax distance offshore
hannbl
bic yards
np
ise/ Boatlift
,ulldozing
X ►S "
eLength
-
not sure
yes
no
s: not sure
yes
no
'ium: ' l n/a
yes
no
yes
no
Attached:
yes
no —
ng permit may be required by:
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Applicant:
Permit
#:�2sb
5b
Date:
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Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
found in your Habitat code sheet.
TOTAL Sq. Ft.rdisturbance.
Sq. Ft.V
INAL Feet
(Applied for.
ted finaAnticipated
fine
DISTURB TYPE
Habitat Name
Disturbance totalisturbance.
Choose One
includes anys
anyxcludes
any
j
anticipatedtionestoration
andh
restoration ortempmp
impact
temp impacts)
mount)mount)
«}—\ Dredge ❑ Fill
Both ❑
Other W10
�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 ❑ Fill ❑ Both ❑ Other ❑

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ADJACENT RIPARIAN PROPERTY 0"RR STATEMYNT
(FOR A .PIER400R,1'N(;PXX Na&W.4 271.p'I/B0,4/i�'HOUSE)
I hereby certify that .l own property Adjacent to k- i AFC 's
(Name of Property Owner)
located lit _ / .9
(Lot, Block, Rosa, etc.)
(Waterbody) (Town and/or County)
phone �{: `�/P .e fey -1( J Mjtlling Address: /5��2 1 r 4, 40�
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lie has described to me, *a shown below, the developmMt ho is proposjng et that location, and, l
have no objcetiong to his proposal. X mdorsund tktat it pier/mooring pi4inge ! boattift / boothowe
must be sat back a minimum dis%Mt of fifteen feet (l 5') from my area of riparian access unless
waived by me, (If you wish to waivt the setback, you must initial the appropriate blank
b4do,w.)
T t A un with to waive
< < I', #o wish to waives that setback r4MgUit4rA0nt.
Y.-6ESC�jpjjoN AND/OR DRA*riNd'0F'Pkt6P0ftb DZVELOPIVXMTI.^~
(To be f11led In by individua l proP0tln$ dev 4*HWnt)
(InforrAsoon for Property Owner Applying - (Riparian Pmperty Owner InformAtion)'
for Permit) rf,
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pity/8tat ip Feint or Type Nemn
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