62523D - Riverview

CAMA /� DR5DGE & FILL -
hIENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC -).-OLD
ZRules attached.
Name \yWZVILAV MWI'r 'Ow g— Lt-(, Project Location: County PC�J ",
C/- C kip ►5 17,v�
4 A 1 L_ ACC State NL ZIP �64(Ag
Fax # ( )
A Agent
❑ CW ❑ EW Li PTA ES PTS
❑ OEA ❑ HHF IH _ UBA N/A
❑ PWS: ❑ FC:
Street Address/ State Road/ Lot #(s)
3 i I�w 1 r'J
Subdivision
City yV-} ZIP
Phone # ( ) River Basin
Adj. Wtr. Body_ W iwa-- tr Fit (nat /n
,es / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body rY�
Project/ Activity ('t:. 1 Y 1; .� t" j >-► r > iG..
(Scale:
ii .
k) length �, iA4
gth
fiber
/ Riprap length
distance offshore
distance offshore
innel
_
I
-t
is yards
p
e/ Boatlift
Ildozing
k
Length
not sure yes -XIO
not sure yes
im: n/a yes 49 t
yes
ttached: yes4
I
---
g permit may be required by: ��� (1), ❑ See note on back regarding River Basin
inPcial Cnnr itinnc a i i % %�TC -11A 1 2 r,.-1 I rV A� 1 (ATV,-r --- f A t -

kpplicant: f s �F1 Permit #: S Z 3
)ate: 7/ ,Z/) 3
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
fund in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
abitat Name
DISTURB TYPEJ'Z
urbance total
disturbance.
Disturbance
disturbance.
Choose Onecludes
any
Excludes any
total includes
Excludes any
nticipated
restoration
any anticipated
restoration and/or
storation or
and/or temp
restoration or
temp impact
m impacts)
impact amount)
tempimpacts)
amount)
A
v
Dredge ❑ Fill ❑ Both ❑ Oth
�J
3 LDredge
❑ Fill ❑ Both ❑ Othe�(�
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 ❑

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to R1' v f CU1' ►" (W-Mo rt'R l /'IJ ILC's
(Name of Property Owner)
property located at 41�,� , I / 7 /✓ ! /A+h Af L .1 R Y
(Address, Lot, Block, Road, etc.)
on — �., ��. � � t cnge- e"i, in - JAfA t �� r N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatior
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
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wain
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 Information) (Adjacent Property Owner Information)
U�Signature
✓ �NMcri-/L-/&L�C
P " t or, Type Name
o 9c)K 33i
Signal, el
C'U Pe l'APt aZSA
Print or Type Name
9 q,�-7 Hwy /I 7 /d

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT /
I hereby certify that I own property adjacent to kv P r' Jj) rc✓ l r f y�e m o r l I/ I p A r J1 L 's
(Name of Property Owner)
property located at 3 3 f) w 112 N
(Address, Lot, Block, Road, etc.} .
on , ink�A , PPti��� , N.C.
(Waterbody) (City(/Town and/or County)
The appH as described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till 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
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.)
W - - i do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property 9wner Information) (Adjacent Property Owner Informa . n)
pp Signature I g lure A
IL1 re f`J i'rW- MeM ore' I qr LL �,{� ri s 4ro"A- I'A ucc)
Print or a Name OwuY� Print or Type Name " '
i �
)P 6 Ad ), 3 9D q o U SC 1� �C-v X ­f�
g Mailing Address _ _

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DCM WILMINGTON, NC
JUN 1 9 2013
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