61548D - Hall

I CAMIA / `-1 DREDGE & FILL V w
'ENERAL PERMIT Previous permit #
JNew E]Modification LComplete Reissue El 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
� ' _ Rules attached.
t N e h Project Location: CountyrU
1 ily-� Street Address/ State Road/ Lot #(s)
� � _ State�r� ZIP - tL. `� J /�'�'� GYl !'"�•C .�3�'.P-f+
�-143
-;'Fax # ( ) Subdivision NIA
:ed Agent Vj City O(' aK �5b ZIP
❑ CW i EW .1 PTA -- ES ❑ PTS Phone # (1 I ) River Basin ❑ OEA ❑ HHF IH UBA ❑ N/A Adj. Wtr. Body N `(j
❑ PWS: -i FC: „ 1
yes no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body F� 1 w w
' Project/ Activity
i
ck) length 1
1(s)
ier(s)
ngth
tuber
J/ Riprap length
distance offshore
x distance offshore
lannel
)ic yards
ip
se/ Boatlift
Adozing
I V t. L 1 Y l i l,v
Length _ O
i.
not sure yes 10
not sure yes --
wm: n/a yes no
7
es no X'
I- — _
lttached: yes xn
ig permit may be required by: �l�nl ►1 G 1 �t l I c1(( g f ((` .
(Scale: I
❑ See note on back regarding River Basin rl
A (_J 1

Applicant:
Date:
Permit #: � 15Lf � b
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTALJc
NAL Feet
(Applied for.
(Anticipated final
(Applieticipated
fins
DISTURB TYPE
Habitat Name
Disturbance total
disturbance.
Disturbturbance.
Choose One includes any
Excludes any
total includes
any
anticipated
restoration
any antictoration
andh
restoration or
and/or temp
restoratp
impact
tem impacts)
impact amount)
temp imount)
U IW I Dredge ❑ Fill ❑ Both ❑ Other I 13 l I � n I I
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 ❑

3887
88-112/531
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A JI? AGENi RIPARIAN P ,OP R. T1' OWNER STATEM901
I hereby certify that I own property adjacent to J0 H N 14A L-L.- s
(N me of Property Owner} � fit\
property located at y3 REET Mbogoel STLOT— �t )
(Address, Lot, Block, Road, etc.)
an M MyrOt1 a✓I r , in OGe7,,0 15uL- E-t N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAMNG OF PROPOSED DEVELOPMENT
(individual proposing development must till in des cr ion below or attach a site drawing
o�v R'6� )i
(�(jl,ER SECTION '
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from,,mm_y area of riparian _Sccess .unless vraived by me. (If you wish to waive
the setback, you must Initial thWapproixiste blank below.)
I do wish to waive the 15' setback requirement.
W"�
.
I do not wish to waive the 15' setback requirement,
Otiv er Info n) (Adjacent Property Owner Informatio
L
ature ture1� A-(,0 BU9TotJ
or T B Name Print or Ty�ef(lame
Malilajt Address , . , -- Meg in8 d Anc,r„ , r wri

ADJACENT RI?ARIAN PRQegJ `nWNER 6TATEM NT
I hereby certify that" i own property adjacent to J64fJ W-A L.L. _ s
property located at. `t 1.5 MiN KOe 51-EECr _L4 2 - j& 21
on QI, iHr4 MAW CAiY&L., (Address, Lot, Block, Road, etc.)
in CX A Q IS E' QE'A-[.t-+ , N.C.
(Waterbody) (City/Town and/or County)
The appilcant has described to me, as shown below, the development proposed at the above location.
i have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
ondfvidual proposing development rdon below or attach a site &,swine
OT C5 ?4�
�>> 71,
I
�. WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15 from my area of riparian access uniess waived by me. (if you wish to waive
n the setback, you must Initial the appropriate blank below.)
I do wish to waive the 151 setback requirement. ---P WaNe 5' MAi n Ain
I do not wish to waive the 15 setback requirement.
Own inf rm on (Ad cent Property Owner Information)
Z. c.. ;rr
or
2r
(�}5 MortPne sr)
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Telephone Number Telephone Ntfmbe�

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