62586D - Harts

CAMA / DREDGE & FILL iv' 62
i E N E RAL PERMIT Previous permit #
New _ Modification _Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources J ����
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 7H, 1
ules attached.
Name Project Location: County
yi Street Address/ State Road/ Lot #(s)yI
(Z L r�vJ State ZIP Z`>
Fax #
zed Agent
Id CW EW _ PTA ES PTS
OEA HHF IH UBA ! N/A
PWS: FC:
yes / no PNA yes /epg) Crit.Hab. yes / no
A Project/ Activity : ; G l 'A�-
ock) length"' `- tj X
m(s)
length
umber
ad/ Riprap length_
vg distance offshore
iax distance offshore
channel
ubic yards_
imp
)use/ Boatlift
Bulldozing
Subdivision
City I�X,t 4-6-A-e-� ZIP
Phone # ( ) River Basin 6 API
Adj. Wtr. Body /VL- C 1 at
Closest Maj. Wtr. Body L [ Le,
(Scale: I
11111111E
■ow ME M■■IN ■
No
... VWKWZ
...

Applicant: ��j�I t12 I
( � Permit #:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
-labitat Name DISTURB TYPE Disturbance total
disturbance.
Disturbance
disturbance.
Choose One includes any
I
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration andlo
restoration or
and/or temp
restoration or
temp impact
-j tem impacts)
impact amount)
temp impacts)
amount)
OW Dredge ❑ Fill ❑ Both ❑ Other U45)
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 ❑

3012
66-112/531
Date
D � I s cZ eop
Dollars
a Be
IPANY W
52027321397un030L2
COLONIAL

12 13 01:31 p Discovery Place Child Car
9102702269 p.1
&INA.
NCDENR
North Carolina Department of Environment and Natural Resou,ces
Division of Coastal Management
Pat McCrory Braxton C. Dmis John E. Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
I e of Property Owner Applying for Permit: Na of Authorized A nt for this project:
er's Mailing Address:
'hone Number (zn Y-71—©65
Ag it's MailinaAdd rass:
Phone Number (Fle) a12.2 r3e92 9,"'—
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the fcl�wing (activity):
'or my property located at
'his certification is valid thru (date)
01
aperty Owner Signature
Date

13 01:32p Discovery Place Child Car 9102702269 p.2
",A
rum

2 13 01:02p Discovery Place Child Car 9102702269 p.3
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Dole 's
property located at f4^
(Address, lot, Block, Road, etc.)
an i✓r^ J " /`z in N C.
(Waterbody''—(ektyffown a/or County)
The applicant has described to me, as shown below, the development proposed at the above locatior
Ct,ld 1 have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse lift, or groin must be set bac
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wa
the setback, you must initial the appropriate blank below.)
+�awz.LcLwish to waive the 15' setback requirement.
I do not wish to waive the 16' setback requirement.
(Property Owner Information) (Adjacent Property Owner I ormation)
_�� S ham'-- s W// �
Sig ature Sinature
%ar
Print o ype Name - Prnt or Type Blame ,
L & 1,S-1a `'t " I�igS Rr �tr i� 11 rim
Maiiinn 4Hr1racc Maifina Address

1.2 13 01;32p Discovery Place Child Car 9102702269 p.4
Ix orCOMALIWMACmun
r f'
�.�r •rah► +�r�.�.�rr�lrr�it Mr..Mr iw � �r��';�t,
I�M� ����,srr�ts�lrl�tl�s+i�.osa�
�''�leil�rae���i�►�t�r.■. a�lia�s.iM �•:r�Il�lt�

2 13 01:02p Discovery Place Child Car 9102702269 p.5
ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to Z' 114�11 ffu /I2� S
t (Name of Property Owner)
property located at !S 5 �i ✓r �j en %�
Address, Lot, Block, Road, etc.)
i
on �vl in(AA/, ✓'a: N.C.
(Waterbody) j (Town aKdfor Cou )
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
-6
Date

2 13 Q1:.32p Discovery Place Child Car
9102702269 P.6