61558D - Hargett

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CAMA / :—] DREDGE &FILL -
GENERAL PERMIT Previous permit#
(New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources 1 ! �7 •,
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
ules attached.
nt Name { . VM Project Location: County lx Vfbw� ti'
s 156b2 Street Address` State Road/ Lo #(s) � tate ZIP 1 I ((' ' .fi
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❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑ FC:
yes / no PNA yes / no
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pier(s)
ength
umber
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rg distance offshore
iax distance offshore
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rrium: n/a ;es) no
Attached: ves ! ne
ling permit may be required by: OW
Adj. Wtr. Body nat
Crit.Hab. yes (no) Closest Maj. Wtr. Body
(Scale:

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, CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
lame of Property Owner:
kddress of Property: �'1 �'rjpti,� g �..` v—
(Lot or Street #, Street or Road, City & County)
ft-
,pplicant's phone #: 7P!f Sq (- 7(g S Mailing Address: CA 6#t 6r.J( t
yK446-w s V% • L Z1 0o y
nereoy certify that 1 own property adjacent to the above referenced property. The individual applying for this p
tas described to me as shown on the attached drawing the development they are proposing. A description of dra,
vith dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
.f you have objections to what is being proposed, you must notify the Division of Coastal Management (DI
n writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drivi
Nilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response
:onsidered the same as no obiection if you have been notified by Certified Mail
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distan
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial th
appropriate blank below.)
I do wish to waive the 15' set back requirement. pj �(G� pP—rk.-&-->AAe
" 1 `i 10
I do not wish to waive the 15' set back requirement. �y �O ��--'
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Property w er I ormation n r e ner Inf
i ature Signa
Print or Type Narrk Print or Type N e �—
Mailing Address Mailing Arress I
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Permit #:
,pplicant:
W P j
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late: U
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
fund in your Habitat code sheet.
ibitat 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
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)
gWDredge ❑ Fill ❑ Both ❑ OtherA
t ZS
1-2—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 ❑

HOLDEN DOCK & BULKHEADS �5-,'5203 5069
IEGORY A. & DOROTHY HOLDEN
JCDL 4576438 HERS NCDL 5202642
PH.910-842-9732
1502 STONE CHIMNEY RD.
SUPPLY, NC 28462
DOLLARS �t
`.- First
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