62539D - Musgrave

CARM / __`DREDGE & FILL
GENERAL PERMIT
-New -Modification El Complete Reissue -Partial Reissue
Previous permit #
Date previous permit issued -
rized by the State of North Carolina, Department of Environment and Natural Resources
(� d
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
it Name / J43
��
❑ Rules attached. f
Project Location: County S(0 t )
L4 S IJ •
Street Address/
State Road/ Lot #(s)
State - ZIP
`ll1j(.-�Ziz�
Fax # ()
Subdivision
:edAgent_
t- I
City
S ZIP 24/6
ElCVNMEW
PTA J ES _ PTS
Phone # (
) 1 River Basin
❑ OEA ❑ HHF
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
r R`J)W (C'_ bAeLf nat
❑ PWS:
❑FC:
Crit.Hab.
Closest Maj. Wr. tr.
Body ✓✓► f7 SO IJ %`>
yes / no1 PNA
ye:s) no yes / no
f Project/ Activity
1 v► 5401 yip`
I P �am Cl
O1, w4
, a,-^ c
(Scale: I„_
)ck) length
fier(s)
!ngth
amber
prap length %
g distance offshore db-.
ax distance offshore 'b—
hannel
bic yards
mp
ise/ Boatlift
Bulldozing
ie Length
/ i
not sure
yes
no
;s: not sure
yes
no
rium: n/a
yes
no
yes
no
Attached:
yes
no
ing permit may be required by: ❑ See note on back regarding River Basin

plicant , `\ ' U�. OA vs Permit # z•�
le:
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
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 ❑ Fi Both ❑ Other ❑
( ,?)�jv
Dredge ❑ Fill ❑ Both Other ❑
7S
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 ❑

'TRUCTION, INC.
ETT LANE
RY. NC 28460
BankofAmerica.1.
ACH W 05%=196 '
66-19-530
4841" 1:0530001961: 237015337748us
2484)
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. -
Address of Property -
(Lot or Street #, Street or Road, City & County)
Applicant phone #: C� �' ' Mailing Address:
i hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you 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.nccoastalmangement.neticontact—dcm.htm or by calling 1-888-4RCORST. 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.
information) (Ri rian Property Owner Information)
Signature
Print or 9pe Naml@i
ne.,;r;-- AAA —di
Print or Type Name
d 530 us t6g74 oi-

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ct I) a.(� (3
Name of Property Owner Applying for Permit:
I certify that I have authorized (agent) «{o ' 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) c� `) R(( (,VW kj)
This certification is valid thru (date) 1 —
111LZrr 12A AIM 61 /6 - o?%