61689D - Fullerton

LAMA /, DREDGE & FILL
ENERAL PERMIT
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 —+'
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC • I aL
----
t Name T f ID
ARules attached.
Project Location: County
i i✓ f S.+ UQV,
R
Street Address/ State Road/ Lot #(s)
State ZIP
Fax #
Subdivision A
sue)
zed Agent SrL)
City ZIP
Cw EW PTA ❑ ES C PTS
Phone # l l I �— 0 • River Basin
i
OEA HHF IH ❑ UBA ❑ N/A
I y � . 11. 0 {
Ad'. Wtr. Bod IW W nat
❑ PWS: ❑FC:
y}
yes / no PNA yes / Crit.Hab. yes /
no no
Closest Maj. Wtr. Body ry�w�
Project/ Activity
ine Length " m f
not sure yes
I
igs: not sure yes no I
I
)rium: n/a yes
es no
Attached: yes n4 l
�1
Ping permit may be required by:�YuncWdL
1 a� ❑ See noteonback regarding River Basin
C'- _0-1 �`�.,a:«:....� 111 - 7 (J\ n In A A I l I �t 1. 1 If" 7A I e!'1w Le iA rl L.J I -f i 11.41111 It. a.

plicant:
te:
C� I
l�
;cribe below the HABITAT disturbances for the application
nd in your Habitat code sheet.
Permit #: 6 ( G �j )
All values should match the name, and units of measurement
TOTAL Sq. Ft.
(Applied for.
itat Name DISTURB TYPE Disturbance total
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)
wv Dredge ElFill ❑ Both ElOther
tLC1
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 ❑
Lk/ «= IV]

SON
JCTION
Date
MPANY
OVAL
S 2 1 S 2S3tl t.13 9 2 *A w; ....
........ . .. 1- .... ... ..... . . ......... ....... ... .......... ...... m.4p;
5341
66-112/531

in..11.2Q13 11:19 AM Richardson Const & Marine 9108425597 PAGE
4,-3--
ql 0 ~ 3 7 -
il-
Ck.
(It
L.14- LLA 1. -1 1 1 1-u
2/

un..11.2013 11:19 AM Richardson Const & Marine 9108425597
MOINUMSIMMIJI
i hereby certify that I own property adjacent to r ,s
property located et IL, ! ;�.r \ Name of Prolftrty owner)
on
in 1.ULA , N.C.
( IWTown andlor Cowtty�
PAGE. 3
The pticatnt has described to me in shown below, the development proposed at the above
IGC�t' �.
I have no objection to this proposal.
t have objections to this proposal,
DeSCRIPTION ANCHOR ORAWWO of PMVOSED DEVELOPMENT
(irrdividurtl prroposirag developmoM maw Ills In 40100rfptlon irrrlow or aftch a sNo drawing)
<i PIL VN
. t�t "kt '
t n17'
S e-.4-, '-"-ELC� eA
i onderstand that a pier. dock, mooring pilings. bre�r, boathouse, lift, or groin must be set
bwk a minimum distance of t5' From my area of riparian amass unless waived by me. (if you
wish t4 w, Iive the setback. you must k tial the appropriate blank below.)
I do wish to waive the I S* setback requirement.
l do not wish to waive the 15' setback requirement.
(Prapwly Ovvmrbrio
¢orttr er Inft�rmat{a�n
of 1Yoe

un,.11:2013 11:20 AM Richardson Const & Marine 9108425597 PAGE. 4i
t
i hereby certify that I own property adoaent to s
(Ntate of Property Owners
prcPerty !ac>stad at _ � U ! �' t� �� � y r t ,
(Address, Lot, tack, Road, etc)
on L vj Vj In .�`� t. C N.C.
(�iWaterbody) K eWn andtor Countv1
The applicant has described to me, as shown boiaw, the development proposed at the above
toestion.
I have no objection to this propoa*.
I have *actions to this proposal.
DEISCRIP110N AND/OR DRAWING OF: PROPOSED DEVELOPMENT
Ondivh*M proposing development most MI In descrlpvt/on bekw or *Mob • site drtrwlrW
I under�nd that a pler, dock, moorlrtg p zings, breakwater. boathouse, Aft, or gran must be set
beck a minimum datance of I& from my area of riparian access unless waived by me. (If you
wi h to waive the aetback, you must Intti l they appropriate blank below.)
�� I do wish to waive the 1 S' netback requirement.
I do not wish to waive the 1 S' setback requirement.
(Pr��yr Owner iNa Matson) (Ar 1"mot Prnpartyr pawner 10 t�nnotlon)
Telephone Number
!_3
llw— _ ,r✓. ,..__ ....,u,� .._
e nrrr