62620D - Orazem

N© ��
CAWIA / DREDGE & FILL
E N E RAL PERMIT
Previous permit #
ew ❑Modification Complete Reissue
❑Partial Reissue Date previous permit issued
ed by the State of North Carolina, Department of Environment and Natural Resources
It
astal Resources Commission in an area of environmental concern pursuant to 15A NCACQ
Name- 2Ai--O 'CV2 A�A
ides attached.
Project Location: County RU-4f�YL
-1-1 j\4)-q 4 �2,
Street Address/ State Road/ Lot #(s)
State ZIP-
--j 13 Fax # ( )
Subdivision
zed Agent ti"L._l 1 � iVr _4P1�- �[�
L C-it& .cnV ,-,City ZIP__ 144
Cw EW :3pTA ❑ ES ❑ PTS
Phone # ( ) River Basin
OEA HHF ❑' IH ❑ UBA ❑ N/A
Adj. Wtr. Body - C j 1 < (gat.
PWS: ❑FC:
yes / no PNA tes / no Crit.Hab.
yes / no Closest Maj. Wtr. Body C I V---
Df Project/ Activity S ` -A L { 1 L -1 'C a 2 "�� ,��I 1. I N 5 A7 bC 131, e ,1 'U
(Scale: L
lock) length
Jing permit may be required by: J-'JA "Z— ❑ See note on back regarding River Basin
— . . — .... A .'% _ Ie- 1 , ,A- -

kpplicant: Gi��(� -- Permit #: �� ` 20
)ate: q j1-7/B
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Fund in your Habitat code sheet.
labitat 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)
�'�, /
u � `�
Dredge ❑ Fill ❑ Both ❑ Other
I C
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 ❑

IE CONTRACTORS, LLC
910-367-2159
12 HAROLD CT.
PSTEAD, NC 28443
J\J- (Z-
it/
08-03
l tom' 6) � ZGzz>
.0060 38i1' i:0 5 3000 L 96':
6038
Bank of America 66-19/530 NC
ACH R(f 053000196 58754
00068L.?43?38ll'
$02o© --
DOLLARS 8
_ __ -­
_ ...... - w

ADJACENT RE_RIAN PROPERTY
I hereby certify that I own property adjacent to -3 Pi operty located at (Nan* of Property Ownprj
on (Address, Lot Ellock, R9
v
e,
(Waterbody)
CityrrTown nd/or County)
The applicant has described to me. as shown below, the development proposed at the jt)ove
I-ocation
I have no objection to this proposal
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
`Individual proposing development must fill in description below or attach a site drawing)
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
(property owner laformiation) (AdjaceriifProperty Owner Information
I narwe
t or Type Matrio
rVdctass
I
CAYlstqt`�

RECEIVED
A-QJACI"Nl -RIPARIAN PROPERT
Y UW NEF
I hereby certifjl that I own property adjacent to C-, -e ✓k d, s
(Name of Property Owner)
property located at /j a k- i 4 -e- /' '�' �"
(Address, Lot, B", load, etc,)
in Jec (-h "V
ipl
(Waterbody) (Cityrrown, and/or County)
The applicant has described to me. as shown below the development prolx;sed at the above
localigri-
I have no objection to this proposal
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individuai proposing development must fill in description below or attach a Site drawing)
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, flf you
vvis,i to waive the setback, you must initial the appropriate blank below)
I do Wish to waive the 15'setbar-k requirement.
I do not wish to waive the 15'setbar* requirement
(property Owner Information) (Adjacent Prop" Owner Information)
Signature
Ki=nqlure�,-
Print or Type Nerr+e �^
l;n—tor Type Norm
e —1;
MaN . ng i A 4 A),C 1�qi Wmg, Ad"Irle 4J C C-0 r - =Uy 0 '7 t,, Y -4 7
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