62671D - Gore

LAMA / DREDGE & FILL wfl' v�
36'ENERAL PERMIT VVV Previous permit#
-New - Modification -Complete Reissue ElPartial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources I Luc)
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
it Name ! ` Y Project Location: Countyti67�v, S ut-�-
i i t . 1 i Street Address/ State Road/ Lot #(s)
i
State r\[ r zi P 11
�- Fax#( )_ —
�ed Agent
❑ CW EW _ PTA -ES PTS
❑ OEA HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes J no PNA yes no Crit.Hab. yes / no
Project/ Activity
ock) length
m(s)
pier(s)
length
umber
ad/ Riprap length_
vg distance offshore
iax distance offshore
channel
ubic yards
imp
ruse/ Boatlift
Bulldozing
ne LengthC? .__ ....-...
not sure yes npo`� T
gs: not sure yes no 1
wium: i n/a yes no — - - --� -
Subdivli;'ion 1A
City r We-" 6eei LL - zips
Phone # ),�-7 (}' (,?rJ j C River Basin uw
Adj. Wtr. Body ri (naf'
Closest Maj. Wtr. Body t-r't wv�
(Scale: 1
yes no
Attached: yes ( not
ling permit may be required b See note n Y � ti it o back regarding 9 Y ( 1�., J T.� ,, ❑River Basin
�W i� � T TTU � CI tX �,�. •
/ CnarW i'nnen*in TL -' 111,4it iA A All tr A OV 1 A-7 A i <4-7,1. (i iw A _ 1 iA . /. I 1 -f r'i 1 I —i� .!L < /) .- ,-j .

NC Division of Coastai Mgt, Habitat impact Computer Sheet
Applicant: Cv ,
�n gym' Q, C Permit #:
Date: i O/-3 1 ] I
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
found in your Habitat code sheet.
Habitat 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 fine
disturbance.
Excludes any
restoration and/
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
I O
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Ot4E]
Dredge ❑ Fill ❑ Both ❑ Ot
Dredge ❑ Fill ❑ Both ❑ OtDredge
❑ Fill ❑ Both ❑ OtDredge
❑ Fill ❑ Both ❑ Ot
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [I Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

& BULKHEADS F¢,
695159203 5439
)ROTHY HOLDEN
IERS NCDL 5202642 �Shield�
B42-9732
CHIMNEY RD,
Dare
NC 28462 i
4t ,
Bank`'`
`0001S?S30110 S

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03-2007 10:02 From: 7a:846 No
C—IRT) D_NCAIL - RETUBMAMS PLRL�QSMED
Q1V IS10 Of CO STAB MANAQEMENT
ADJACENT RIPARIAN PROPERTY QMEt&N� "�QbMAiVER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals limd below, The CAMA General Permit application pr..cadues require that applicants provide tht Divis
Contal Management confmnation that a written stawn- mt has beat obmmeEd signed by dna adjacent ripotNn property
indicating that they have no objection to the proposed work 9z that the adjacent riparian property owners have been tin
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a
contractor or other individuals acting as an audumiud agent on behaltof the appiiont.
This form was sent to you by the following lwdWMual or company desigaated by the appl'fcant as an
2uthotvad mamt:
Aud1orkwd AW-S Signature
Name of Individual Applying For Permit:
Address of Property:
(Lot or Street 11,
(City and County)
Date
or Road)
I hereby certify that I own property adjacent to the above-referencedpropem. The individual applying for
has desettbed to ark as shown on the at gched drawing the development dwy an proposing. A description e
with dimensions, should be provided vrith this letter.
I have no objections to this proposal.
It you have objections to what Is being proposed, please write the D"lon of Coastal -Manage
Cardinal Drive Extension, Wilmiagton. NC 28405 or call 910-796-7215 within 10 days of receipt of
No response is considered the saafe as no objection if you have been natilied by Certified M2iL
WAIVER SECTION
I understand that a pier, dock. mooring pilings. breakwater. boat louse or bout lift must be
tulaumum distance of IF from my area of riparian (access-_uatess waived h lase. (U you wish a
setback, you must initial dw appropriate Mask below.)
I do wish to waive the 15' setback requirement.
i An ant -A.h rn .senor rh- 1 4c, AVMWA

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