61582D - Harper

LAMA / DREDGE & FILL N' 61
IENERAL PERMIT Previous permit# New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of envirgnfnental concern pursuant to 15A NCAC
Rules attached.
Name f'e! r f�7 1 df ti? Project Location: County'N
-y
Street Address/ State Road/ Lot #(s
-- — State /.%e-1�-ZIP—
(' c`) e;/ '•', Fax # ( ) Subdivision
:d Agent
CW r! EW PTA ES L PTS
OEA HHF IH UBA ❑ N/A
PWS: FC:
yes no PNA yes / no Crit.Hab. yes no
Project/ Activity
lock) length V
rm(s) k /
pier(s)
length
camber
gad/ Riprap length
ivg distance offshore_
nax distance offshore
channel
:ubic yards
amp
ruse/ Boatlift
Bulldozing
ine Length ��
not sure yes
igs: not sure yes
xium: n/a yes
yes
Attached: yes
ling permit may be n
City
Phone # i�f
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
(Scale: /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LOE'.dt -G1r00 kS 4x Is
property located at 0 }�/` h e 'Y�e. - �( m of P�rOop�r� O ner)
(Address, Lot, Block, Road, etc.)
on W ti C�'e�e�� , in S WOL j s Wt r ry 1J C1 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locat
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description1below or attach a site drawinc
IQ,
41
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bi
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to v
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) (Adjacent Property Owner Information)
Signature. } / Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LOe4t 1�. Y0Ok5 44rf ee- 's
c (Name of Prop rty O ner)
property located at �d �l rt� J �°�e-� (. 5'�"W �'� L.
(Address, Lot, Block, Road, etc.)
on _ 1 He4b in 5kKOL4 5 Wr ry tJ N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loca
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description1below or attach a site drawin
lo,
•VMIV G1N JGV I IVIV
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set t
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
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.
e
(Property O ner Info ation) 7dJa nt Pr erty nmagInformatio
:!ig-kwure r rure / 1
Letd{ oC ✓a,
Print or Type ame Print or Type Name
In At) AA11 J./ �... �Ql�1�A✓ O�_ el ( nA ..,

-ibe 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
it Name Choose One includes any
anticipated
estoration or
mp 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)
Dredge ❑ Fill ❑ Both ❑ OthEll
Dredge ❑ Fill ❑ Both ❑ Oth
Dredge ❑ Fill ❑ Both ❑ Oth
Dredge ❑ Fill ❑ Both ❑ Oth
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 ❑

2102
CAN
66-112/531
`7
/10?
3 AND YR COMPANY :7
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