62540D - Chennery

CAMA•/ DREDGE & FILL r
ENERAL PERMIT Previous permit#
New 'Modification —'Complete Reissue GPartial Reissue Date previous permit issued_
rized by the State of North Carolina, Department of Environment and Natural Resources /�-
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
/❑" Rules a ched.
t Name he ,✓ +¢' Project Location: County_44"7/H
�'l Street Address/ State Road/ Lot #(s)
State NG ZIP , j ( C.G.,.
( ) # ( ) Subdivision
zed Agent ►4 A 7
/,G'�/ Cityn
�� ZIP
CW EW PTA LiES PTS Phone # ( ) River Basin
OEA HHF ❑ IH ❑ UBA , N/A Adj. Wtr. Body �G4� ��'� �/i+ A--(' nat
PWS ❑FC:
yes / no PNA yes �o` ' Crit.Hab. yes / no
Closest Maj. Wtr. Body
A Project/ Activity
lock) fen#h L. ' X I Z.
M(s) ! EaI V L¢� r,
piers) 'Z ,
length
umber
gad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp �—
�usef o�8 atlift�
Bulldozing
ne Length
notsure yes o
gs: not sure yes "
mum: n/a yes o
yes no
Attached: yes no
oeq f
(Scale://
uv�
ling permit may be required by: ��� � % (� �e note on back regarding River Basin

)plicant: 6—
ite: 13
C16 If-hrl ply, Permit#:
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)
j{
bU� Dredge ❑ Fill ❑ Both ❑ Othe
3 V
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
ill ❑ Both ❑ Other ❑
ill ❑ Both ❑ Other ❑
ill ❑ Both ❑ Other ❑
VDredge
ll ❑ Both ❑ Other ❑
ll ❑ Both ❑ Other ❑
l ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

MIKi
Bank of America 5920
RINE CONTRACTORS, LLC 08-03 ACH R/T 053000196
910-367-2159 66-19/5 5B154
92 HAROLD CT.
4MPSTEAD, NC 28443
14l
0
7d ov I N
'000�/
DOLLARS 8
� 4 Z5 �fl> Gil
AUTHORIZED SIGNATURE
005920o■ i:OS3000196i: 0006B4?43?3611■

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 6 k ( C 4 eA 9-r y
(Name of Property Owner)
property located at 01 �� rof�,�t +J vl�
(Lot, Block, Road, etc.)
on ©1 JDJ► , in
(Waterbody) (Town and/or County)
Applicant's phone #:
M X7 r8108
Mailing Address:
I
ev u"4&?N.C.
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)
le fii Sage a 6"16P-r•5F 0
i 3 x 3 .Fts-r
(Information for Property Owner Applying
for Permit)
Mailing Address
opsa�/ �P ti, 141�5 4 6�¢r
--------------------------------------------------------
(Riparian Property Owner Information)
r
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to � ( Ch 8,t. - IS
(Name of Property wner)
property located at a rc b Kq-
(Lot, Block, Road, etc.)
on f OP5a(-( w
�y in t _n64azk Pa"A-c- ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: q/9 ZN 1 'U Mailing Address -
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)
5a e- as 6,46- `s
I p 0
_ o
(Information for Property Owner Applying
for Permit)
chi
Mailing Address
12 t 3 6 r-r-j
Ka. Le,(, I k , Are— .2 -1 c, S
rite/CtatP/7in
(Riparian Property Owner Information)
Signature
Print nr Tema T�T�ma

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date `a 2, 55- ( 3
Name of Property Owner Appiying for Permit:
Mailing Address:
I certify that I have authorized (agent) AA�� � /41Rr'kCfM �to act on my
V
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) l �'r' -t
at (my property located at) _ 1 rig CarD l Aoa 13j ��i �St�. ( 8&" AEG
This certification is valid thru (date) C Z f 31 - ( 3
15-/ 3
Property Owner Signature Date