61547D - Potts

_1CAMA / ----'] DREDGE & FILL /'� N(' 61
GENERAL PERMIT Previous permit#
New Modification Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
0 Rules attached.
nt Name U �� 1 i C Project Location: County
i U Y`-I Street Address/ State Road/ Lot #(s)
f .JkiC StateN�, ZIP
o ( ) `1 '�~ � Fax # ( ) Subdivision
1
zed-Agent`�A Cl C.L ZIP L!
j CW ❑,EW CPTA ❑ES ❑PTS Phoner# (G���)rVE
River Basin Ll ail
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A p
Pws: ❑FC: Adj. Wtr. Body La-o. C+--�,r, AiwW (no
yes / no PNA yes 4no Crit.Hab. yes / no Closest Maj. Wtr. Body " J
)f Project/ Activity
i
ock) length f l x
m(s)
pier(s)
ength
umber
ad( Riprap length
+g distance offshore
iax distance offshore
:hannel
ibic yards
imp 7 i
use/ Boatlift
Bulldozing
l 4 -'e) V
?mod
ne Length
not sure yes no
gs: not sure yes no
vium: n/a yes no
J ( yes no
Attached: no
ling permit may be required by:�
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lip. I
kV
W V,
I i'i
(Scale: I i
❑ See note on back regarding River Basin

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— is 1-mmeby a� to
in order to ob�in - ,�
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SPecit OONUMM desk - d in "aitad" oboch_
uxw'noN OF PPOJECT:
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13 13 UD.44a MOn OKUDIC y 1U-040-01 IU
Pl1G-03-2007 10:02 From: To:8429E306
1 ora F& � MI., ms�
The purpose of this forte is to provide piper notice w you ns an adjacent riparian property owner to the individt
individuals listed below, The CAMA General Permit applieadon prcccdum require that applitao4 provide tt►c
C0Qstal MMgancrtt confirmation that a written stararne tt has been obained signed by the adjacent ripnrion pro
indicating that they have no objaaion to the proposed wort 1 that the adjacent riparian property owners havc N
by certified mail of the proposed work Often drew forms arc sabmitted to the adjacent riparian property owner,
contracwr or od= individuals acting as an authorized agent on behalf of the appliam.
This form was scut to you by tine fopowing Individual or company destnatted by the applicont a:
2uthorized agent:
Nameof Individual Applying For Permit:
Address of Property: ZVlk — S 4, d )e—
(W or Street 4, Street or
41-�
end cc")
I hereby certify that) owrl property adjacentto the above -referenced property. The individual applying
has described to me as shown on the sttgched drawing the development they are proposmg A descriptic
with dimensions, should be provided with this letter,
IV07.7 : c�. c l�sF :.4
1 have no objections to this proposal. be-.4cJCA-)G
tf -yen inuvt objections to what is being p"Ixscd, please wrist the Division of Coesml Nan:
Cardinal Drive Extension, Wilmintten. NC 28405 or call 910-79&7215 within 10 days of receipt
No reaponae is considered the same os no object On if you have been notified by Certified ya31.
WAIVER SECTION
I understood th;tt a pier. dock. mooring, pilinp, brcakwatcr, boast house or bout IIR musr I
minimum dis-mace of 15' mom my area of riparian access ._u__nleas waived by me. (U you wish
sr Ir, roe ntnsst initial the appropriate blank below.)
i do wish to waive the 1 S' setback requirement—

F'A
2
4 kv 1 164 'WI %

` I -- �
e of�(�vttblSi Applyfag �'��s� i v�Viit � c� Y�,i/� C�""C" S •
Bess a€ft= Ma
wid Coua!y)
. IT
4t �. +tt i. } +-lTiT4 {'.ti !•- '•ME } ..t :1 it :►. `:1.1r' Lw GT.is:.t i' •`f•:= I it.lt
t..:-ait7: 1. i.l ). E: !': •••t! ,
• fII ttTt[.•rl..`7. )' K '.I+i'L ! ) t• t t.;.! _
fIF 11 .,
1'm Li -- - - ft what 1S %�spiemm wnft
II fl C*r"Imd Drive
�edD� i�o � X� Or caii 9�:0-39:
t h*" deem wed by Mw-L �xne as �o obi
Am°°TaWV*mM b"r, bOa# home *r bout rAft IK
Felt wyarea of .s - an�SS waiFed
we�►t°�raR+�eS,s se , $ tby
��it below
AWL 0tJ
I��w�tot�e 15t �
iga

CCepA
q!q -- 3 z9oqflp
S-0

. , Applicant: Ras
Date:
Permit #_ � 15"--p o
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
`ound in your Habitat code sheet.
iabitat Name
SDI
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 X Both [I Other ❑
Dredge ❑ Fill ABoth ❑ Other ❑
O
O
Dredge ❑ Fill ❑ Both ❑ Other
0
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 ❑
+X14=
AN" -

HOLDEN DOCK & BULKHEADS
GREGORY A & DOROTHY HOLDEN
310-842-9732 HIS NCDL 4576438 HERS 5202642
1502 STONE CHIMNEY RD SW
4924
66-1215/531
640
per
$ Coo, o 0
7XAM
Community Bank
S.Pply, NC 284 -2
77,7 , Ih��.)-4A4, L L