62666D - Ingraham

' CAWiA / --"DREDGE &FILL
� ? 62
RENERAL PERMIT Previous permit #
New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
Drized by the State of North Carolina, Department of Environment and Natural Resources �., 7?
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
/ RuI tttached.
nt Name 4PAP ,v� !� Project Location: County "}} ll e--t i
a
s 2
NP State Ive ZIP '1 r
,zed Agent a J/l ✓ <,
CW ©& '-'?PTA ES ❑PTS
❑ OEA ❑ HHF ❑ IH 7UBA --]N/A
❑ PWS: ❑ FC:
yes / PNA (YesY no Crit.Hab. yes / no
>'f Project/ Activity /1,-r�l
/ia'/lp h
�7-
ock) length
length -- i
umber
ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
u I
ruse/ oatlift
Bulldozing
I
{
ne Length 2r
not sure yes
rgs: not sure yes an
)rium: n/a yes ®4
yes _
Attached: yes X99'
Street Address/ State Road/ Lot #(s)
Subdivision
City i/V/ /t} ,/�i', ZIP
Phone # ( ) River Basin
Adj. Wtr. Body C ew-
Closest Maj. Wtr. Body
/9,
S - (Scale: s
ti
Ping permit may be required by: P, `d. ��•SriYlI � � See note on back regarding River Basin

)plicant:
ite:
INKe 744,1 y-"AAUm
Permit #: O/Z Ao�
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
�itat Name DISTURB TYPE Disturbance total
Choose One 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)
Dom(/ Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
::�Dredge
ElFill ElBoth ❑ 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 ❑

Postage
$
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I Vt D
GTON, NC
Certified Fes
Return t Fee15
�j
Postmark
20 3 Here
:ndorsemeneceRequired)
gestricted Delivery Fee
sQ,OQ
Indorsement Required)
Total Postage & Fees
$
$6.97
10/09/2013
ant To _
QQ
ct
----------------------------------------------------------
Yreet, APt. No.; /
.rPOBoxNo.-_.II L-6 0__--_
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7ty, ¢fate, ZIP+4
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2070i
Sou. August zuut
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
John E. Sk
Secn
AGENT AUTHORIZATION FORM
Date: 0 - q — t 3
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
zl�r-
Owner's Mailing Address:
Phone Number (q7d ) 7 `7Y —
Agent's Mailing Address:
,0 :�- C= r=, Imo., Vr
fu
Phone Number Ao
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
ng+�11 �oQ+��F-+ t•'lic�rl ���
For my property located at
This certification is valid thru (date)
Property Owner Signature Date
DCM WILMINGTON, N1
O C T 1 1 2013

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �R
am
property located at l 2 /,� i erty Owner)
L, e- (N,,;t,—of Pro�
on C �(Address,
R t � , in
(Waterbody)
Roads etc.)
(City/Tbwn and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above location.
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 description below or attach a site drawing)
HECE-i V ED
DCM WILMINGTON, NC
0 C T 1 12013
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 unless waived by me. (If you wish to waive
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.
1(Property Owner Information)
(Adjacent Property Owner Information)
ignature
!� G r--\
Sign r
Print or Tvpe Name
Print or T e Name/
/f

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