61557D - Hargett

—�CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
+� ous
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
Drized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC } }
,,LL P.
les attached.
nt Name Cif N. Y K. Project Location: County T 1/U ttjt 11 il,
ds 15''0J Z t(, Street Address/ State Road/ Lot #(s)
1(�E�tt"l�t,Q W5 State ►yG ZIP 1F51 GU1 ►.� 1Y�.C"
0 () SDI 1- q1g- Fax # () Subdivision Mt i~
zed Agent T n�� pity A-� Ic , )aa a, ZIP
❑ CW YJ EW Q PTA ❑ ES ❑ PTS � 1e # 'MU L River Basin LUW I
El OEA ❑ HHF IH UBA N/A
Adj. Wtr. Body y (& (nat
❑ PWS: ❑FC:
yes o PNA yes �� Crit.Hab. yes / no Closest Maj. Wtr. Body
if Project/ Activity
ock) length x ,
rn(s)'� x 1n
pier(s)
ength
umber
ad/ Riprap length
(g distance offshore
lax distance offshore
:hannel
ibic yards
mp
use/ Boatlift X ��
3ulldozing
CAMP 1-4 XIto
� ,
ne Length ((��
)( i
not sure yes no
gs: not s yes no
rium: n/a YAs no
no
Attached: *yes
ling permit may be require(
(Scale: 1 '*

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Greg Holden
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12/07/2004 19:20
9108429806
GREG HOLDEN
PAGE 01
ADJA I'ItTISioN OF COAGTA7� �ntrz,r_�
= 1'RQPERTY QWNF'ft wr ,
Name of Individual Applying For Permit:
Address -of Property:
(Lot 'or Strom:t , street oz Aoad, C ty 6 County)
I hereby certify thrat I own
reopeferenced property_ The indiv Qua a y adjacent to the above -
described to nc as Shown ore e thattachod apply
for this permit has
they are proposing. A description or drawing, the development
should be provided with this latter. , with dimensions,
— I have no objections to this proposal..
I uhdarstand that a pier, dock, mooring house, lift 9 pilings, breakwater, boat
IS -
from a - midst be set back a minims distance of 15-
Y area of riparian access unless waived by me.
to waive the sethnck, Yost (If you Wish
below.) lust initial the appropriate blank
I do wish to waive the 15tsatback requirement.
I $Q.= Wish to naive the 15 ' setback requirement.

Applicant: W �. 1(� ✓ ��t Y
� Permit
Date: ' t � ` I
Describe below the HABITAT disturbances for'the application. All values should match the name, and units of measurement
'ound in your Habitat code sheet.
labitat 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
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)
ODredge ❑ Fill ❑ Both ❑ Other
S
impact
1 s_ "--
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 ❑
x13 = 16o
�11 , IAU

iOLDEN DOCK & BULKHEADS 6a s9203
IEGORY A. & DOROTHY HOLDEN 5069
XDL 4576438 HERS NCDL 5202642
PH.910-842-9732 /
1502 STONE CHIMNEY RD. DA,
SUPPLY, NC 28462
0 Al- ------------$ G/0 0
DOLLARS (1)
V�
A`1 First
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