62534D - McLaughlin

7�.? 625
CAMAw/ El rJAEDGE & FILL
iENERAL PERMIT Previous permit #
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued r
zed by the State of North Carolina, Department of Environment and Natural Resources
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC /� Rules attached.
Name 6' �<t a v All'A1 Project Location: County l )14
P66 -- k r y f, ,, Street Address/ State Road/ Lot #(s)
' M F � _ State-'" ZIP If 3-7 114 iSf /',e �D ✓ c N
� Z) 5-7 008Z--Fax # (_) Subdivision
A Agent ) , t e�1+J,� r City� -40 � { r7ver
ZIP Z
❑ CW ❑ EW E PTA El ES ElPTS Phone # ( ) Basin❑ OEA ❑ HHF [IIH ❑ UBA ❑ N/A Adj. Wtr. Body m/,41w' • Gt/nat n
❑ PWS: ❑FC: N� Closest Maj. Wtr. Body Jam/
yes / no' PNA e / no Crit.Hab. yes /to
Project/ Activity
:k) length ^ / ry
(s)!�
ier(s) 7 — I' X I U /
ngth
tuber
d/ Ripraplength
g distance offshore_
ix distance offshore
hannel
-np
use oatlift X �3
T / 2 'X7-
3ulldozing
ne Length
(scale./
f
ling permit may be required by:
♦ `s w.
_ ❑ See note on back regarding River Basin

plicant: �� i� �' V \ G t/r 1 1 V, Permit #:
te: L v
- Z2
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat Name
r:
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 ❑ Otbe
1
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 ❑

NSTRUCTION, INC-
ENNETTLANE
FERRY, NC 28460
RAW
1'00236611- --
Bankof America;q- p�
ncr+ Rlr orap166-19-530
2366
n
0
$��
DOLLARS
N

i4.0. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date--,-
2
Dame of Prol,erty Owner ,'Applying for Permit:
I1
1Vailing ddress: e
I certify that I have authorized (agent) _�� _ to act on my
behalf, for the purpose of applying for and obtaining all CANIA Permits necessary to
instals or construct (activity) , i '` .�`1�Y '1 ° (i_,�- '•-dry '' r-,�
at (my progert) located at)
This certification is valid thru (date)
/,Z - 2�
Date

- CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIV?SIOR OF COASTAL i4ANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMA1VER FORM
Name o.` Property Owner. ��A+, 'Mc-1 lAA1_ _
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant phone #: l D 3c�� �� Mailing Address: 1 _
sr��1
I hereby certify that I own property adjacent to the above referenced property. The individual
--applying for this-permittms -descrirbed to me as shown on the attached drawing_the development
they are proposing A description or drawing, with dimensiono, must be provided with this letter.
_ __ ! have no objections to this proposal. 4
I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DC" in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangementnetfcontacf dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.
(P a O%wwnnV Information)
atu; •e
Print or Type Name
9,706, y /-C G �y✓� l�
Mailing Address
e� /V
CitylStaie&ip
00
(Riparian Property Owner Information)
Sign c
Print or Type Name
Mailing Address
CitylStatelZip
re�e„ti,,,,e AH n„hnr

r
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
1. DIVISION OF COASTAL MANAGEMENT
ADJA :ENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORfk;
Name of Property Owner. �� rn C _
Address of Property:
(Lot or Street #, Street or Road, City & County)
"rto'j
Applicant phone #: _ 3;)-'l 34?S
Mailing Address: ooa
I hereby certify that i own property adjacent to the above referenced property. The individual
applying for this permit nas described to me as shown on the attached drawing the development
titey are proposing. A description or drawing, with dimensions, must be provided with this letter.
Ae- . I have no objections to this proposal. 1 have objections to this propusal.
Ifyou have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) In writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimengementnedcontact dcm.htm or by calling 1-8884RCOAST. No
response is considered the same as no object/on if you have been notified by Certified Matt.
WAIVER SECTION
I unders and that a pier, dock, mooring pilings. breakwater, boathouse, or lift 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.
'10� ' do not wish to waive the 15' setback requirement.
pa.rut-Werfril, ion
r,:
Pr. 7t 3r l ype Name
2'7d & orAt L' 6V,"
Mai!" Address
/ d 176,
Gi Stater -� - — -
f4 p
ZCz - rti1- 0013 7-
-
(Riparian Property Owner Information)
Signature -- --
vl %vice-JTIN1
Print or Type Name
91 / 41� Irl
Mailing Address
CitylState! p