62651D - Gallaher

CAMA / DREDGE & FILL �/ /
ENERAL PERMIT Previous permit# r
lNew ❑Modification Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources r
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC l��l Uu
/� El les attached.
t Name V 43 I a Project Location: County C'L
Street ddr ss/ State Road/ Lot #(s
-- State Nn ZIP N 60
0 (_ ) Fax # ( Subdivision PC 1 A"t
zed Agent d 14 G City c4 �/✓% ZIP
j ❑ CW �EW �Q PTA ❑ ES ❑ PTS Phone # l 11 a' Z 3y7 River Basin
❑ OEA ❑ HHF C IH ❑ UBA ❑ N/A ^�
Adj. Wtr. Body -I 0 ✓ na
PWS: ❑FC:
yes / 'no PNA yes / no Crit.Hab. yes /rnQ.- Closest Maj. Wtr. Body
bf Project/ Activity
lock) length
•m(s)
pier(s)
length
lumber
!ad/ Riprap le
vg distance c
nax distance
channel
ubic yards_
amp
)use/ Boatlift
Bulldozing_ !!
�J
t1,. IJ
ne Length
not surf
,gs: not surf
)rium: nh
Attached
(Scale: (11z
ling permit may be required by: 61-`jIO'M,,, G-6 ❑ See note on back regarding River Basin
— 11 ) �7

Permit#: (Z C' S
ate:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and 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. TOTAL Feet FINAL Feet
(Anticipated final (Applied for. (Anticipated final
disturbance. Disturbance disturbance.
Excludes any total includes Excludes any
restoration any anticipated restoration and/or
and/or temp restoration or temp impact
impact amount) temp impacts) amount
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

- -- 2522
Bank of America.
ACH R/T 063=196 ry
,NSTRUCTION, INC. 66-19-530 Jl
ENNETT LANE OC
FERRY, NC 28460
4t arh .
0 5 21i■ I:O53000 L96':
23?0IS33??4811'

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date _ �' 310 lJ
Name of Property Owner Applying for Permit:
&c-Ua hr.a:�
Mailing Address:
4,-!Ir-_& c, Ham m Dcv- of
On Cad S ., ffr✓jA NZ 2bq Lp- 0
I certify that I have authorized (agent) A -H00 6 C�-ff] /1 1 ,1' • to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) %0' 6t yl� LUCI,�,(, u IRLe ,
at (my property located at)
This certification is valid thru (date) _ Ro 14
A-
17 Zi -F 2c,
Property Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Streell, Street or Road, City & County)
Applicant phone #..tD 391 31495" Mailing Address: (Ayl'byi06 QA�)
a 1501 'Enyle-f- Un
'�SOadg krr__ 284 UL
I hereby certify-tbat_lown property adjacent tolbe-.8bove referenced property ThP indivdduaL._
applying for this permit has described to me as shown on the attached drawing_fhe development
theyproposing- A description or drawing, with dimensions, must be provided with this letter.
V I have no objections to this proposal. I have objections to this Po ro sal.
P
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangementnet/contact_dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
waive the setbac , ou must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information
)
ignature
Print or Type Name
23en,-7-fA-oW74 �aV x-ll
Print or Tye Name
A9V 3 r9 / a Af ro o of
Mailing Address
Mailing Address

H
CERTIFIED MAIL • RETURN RECEIPT REQUESTED ()
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street f, Street or Road, City & County)
Applicant phone #Ok 10 3L1�15 Mailing Address: (AV17bV106 �_�)
a'l5a `�EnvA+ Un
2R!� \tx 284 uz
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact—dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
lgnature
Print or Type Name
Mailing Address
(Riparian Property Owner. of tion)
1, -v
Signature
tl
fi � S, J
Print or Type Name
Mailing Address

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