62543D - Keith

JCAMA / - DREDGE & FILL ! ✓ N9 62
GENERAL PERMIT Previous permit #
�211\lew Modification L]Complete Reissue El Partial Reissue Date previous permit issued IT—"
prized by the State of North Carolina, Department of Environment and Natural Resources 4 /,
Coastal Resources Commission in an are4 of environmental concern pursuant to I SA NCAC (�
s C ED Rul s attach d.
rwkName r' Project Location: County <
Strget Address/ Stat� Road/Lot #(s)
r i Stat "ZlP 7 r Ot, a W/ �-1
ax#�_) Subdivision r f
zed Agent
❑ CW
'C EW PTA
❑ OEA
❑ HHF D IH
❑ PWS:
❑FC:
yes // no)
PNA /`Yi;V no
if Project/ Activity
ock) length
m(s)YN UT
i
pier(s) l-
Ll
ength
umber
ad/ Riprap length
vg distance offshore
iax distance offshore
-hannel
ubic yards
imp
$use/ Boatlift—
Bullddzng
ne Length
not sure yes no
igs: not sure yes no
)rium: n/a yes no
yes no
Attached: yes no
ling permit may be required by: _
❑ ES J PTS
❑ UBA ❑ N/A
Crit.Hab. yes j
Phone # (
Adj. Wtr. Body 4
Closest Maj. Wtr. Body
r.
(Scale: 1 ��
See note on back regarding River Basin

��#,e��.
�licant: �L' "� /", C Permit #:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat Name
6rJ
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)
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 ❑
Dredge ❑
Fill 0
Both ❑
Other ❑

3500
002400 0224398
Dollars
3000 50 2 2 4 3 91811' 3 500AP

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFT/BOATHOUSE)
l)
I hereby certify that I own property adjacent to 14�k ( a5c l, KE 14 s
(Name of Property Owner)
property located at �o�!'�Q� lam; l C k V\©c e
(Lot, Block, Road, etc.)
on , in Sr -ye A S F c�- Li N.C.
(Waterbody) J (Town and/or C nty)
Ap licant's phone #: q/0'307'0gq,,)_Mailing Address: 1035 Lh<1 -cJ w k6(--<JQ1reS
Q k `J y 01A 1 -) 7 a s —'�r�c@s Fe e r ti. 1J C Mgr Yb c
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
SI do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
ailing Address
(Riparian Property Owner Information)
Signature

ADJACENTFOR A PIERIMOORAING P L N SIBO OL'FTB ATHOUSSTATEMENT
l )
I hereby certify that I own property adjaccnt to `�F� —s
(Name of Property Owner)
property located at ' a�� `—'fit* Block, Road, ele) --
in F
on ►t �' (Town andlor nty)
(Waterb0 y)
�r;35 C" 11etdt.��ele S�nc+e'S ��-
Ap licant's phone #: a!0-3� 2a � VU Iviailing Address: n 5 (r► i �_ 5� � `! G' d
He has described to me, as shown below, the development he is proposing at that location, and, L
have no objections to his proposal. 1 understand that a pier:moorinp pilings! boatlift 1 boathouse
must be set back a minimum distance of fifteei feet (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 not wish to waive
I do wish to waive that setback requirement. -
---------- ------------------- ---- --------------------
------------
DEScRIPTIOI� ANDiOR DRkWL'VG OF PROPOSED DEVELOPMENT.
(To be filled in by individual prroposing developrneni)
kJc� k-<< rru �i srlNc: ,x
-rji -r f ` 0C K- D�,��ty���t "tom
' + ++ Lk � tr
y' u
�s
-----------------------------------------------------
(Information for Property Owner Applying
for Permit)
ic
Mailing Address
City SStaterZip
(Riparian Property Owner Information)
r signature
t
Print or Type name
305-5_0 10M(a
i e Iephone Dumber

ANN-InamA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
,0 z�13
Date ^:tun � 1
Name of Property Owner Applying for Permit:
Mailing Address:
t 035 d-VYAe4Vi
5
S b rA e-� Die -
r
I certify that I have authorized (agent) J� 0�oJS e A010 h to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity
at (my property located at)
This certification is valid thru (date)
Finnerty l )wner 1►unanire
z� l3
slate