61578D - Denning

—'LAMA / ❑ DREDGE & FILL
GENERAL PERMIT
icjNevv Modification ---Complete Reissue
❑ Partial Reissu
orized by the State of North Carolina, Department of Environment and Na
Coastal Resources Commission in an area of environmental concern pursu
ant Name_ �t �/�_t'�-+/tM
5 1-t'qL 22
State � �-- ZIP ? s
Fax#()
ized Agent
Nat
Previous permit #
e Date previous permit issued
Resources t
ant to 15A NCAC
❑ Rules attached.'
Project Location: County 60;A V j"J
Street Address/ State Road/ Lot #(s)
Subdivision
City `'''
ZIP -L
CW ❑ EW
d
❑- PTA _t ES ❑ PTS
Phone # ( )
River Basin J*,9
❑ OEA ❑ HHF
IH - UBA ❑ N/A
CO�
Adj. Wtr. Body � �+'�
�� �, f" �/
- �- � � (nat
Pws:
❑ FC.
yes / no.% PNA
yes no Crit.Hab. yes / no
Closest Maj. Wtr. Body
A Project/ Activity
t; VJ ; " v
e4.G
0a"1 I'rn� �
dQl k J
ock) length
m(s)
pier(s)
length
umber
ad/..Riprap length
vg distance offshore
iax distance offshore
*annel
ubic yards
,mp
� Boatli �� 1
Bulldozing
n- Length
not sure ye:
gs: not sure ye:
mum: n/a ye:
ye:
Attached: t r"
(Scale: fl
C.
ling permit may be required by: + ❑ See note on back regarding River Basin

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to M l ke Pe rl o l o G is
(Name of Property Owner)
property located at -7 D x k 7 4'% 'S 1-f' r e,+ ,
n h (Lot, Block, Road, etc.)
on -,in ��� �� �-t% on5lot,(-) , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: -I gq 6 9L iling Address: � ��' �, ;2-q�
P"-` r Ak 3
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
(� 1 do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
--------------------------------------------------------
(Riparian Property Owner Information)
Signature

w6 e -Dear i r-,j
/V(
-i�
ItQ,e4r /v-64t�z
��C)5eo
to" AIa b

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLI IFTBOA�THOUSE)
;
I hereby certify that I own property adjacent to %�� (�S� � /P�/j n 1 h 's
(Name of Property Owner)
property located at - <S e e--
(Lot, Block, Road, etc.)
on CIg'y1 �1� , in D O-) , N.C.
(Waterb//yody) qq__ (Town an /or County)
Applicant's phone #: I.I q 2q l L � ZMailing Address: 13 16 A1I6
_? e-VIS O (1 I AJC 0 -70q
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 J9,4ot wish to waive
o wish to waive that setback requirement.
----- --------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
Signature

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date
Name of Property Owner Applying for Permit:
Mailing Address:
0 , L� 6 -3L75-0
I certify that I have authorized (agent) �^r -4 f 4 h,D4P paoyr1 4 e to act on my
behalf, for the purpose of applying for and obtaining all CANLA Permits necessary to
install or construct (activity)
at (my property located at) '7 U � 4A
This certification is valid thru (date 5 - %�j - 1
n
Property Owner Signature / nate

-Jibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
i in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
3t Name Choose One 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)
. /
!N Dredge ❑ Fill ❑ Both ElOth
Dredge ❑ Fi Both ❑ Other ❑©�
2©
Z Dred Fill ❑ Both ❑ Other ❑ ��d
C
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 ❑

LIGHTHOUSE MARINE CONSTRUCTION INC
PO BOX 2532
SURF CITY NC 28445-0028
DATE 7 - / G
=OF / v C 0 ,
/9 . I n
nkof America ��j
UT 053000196
AIS-?s
4570
66-19/530 NC
58754
fi F.1 ,
OLLARS ' ,.,"'
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