61627D - Stephens

'CAMA / DREDGE & FILL M6
E N E RAL PERMIT Previous permit #
New Modification ❑Complete Reissue LIPartial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
CgRules attached.
t Name Project Location: County I'Z'!
/
..5 t°/ /h �+y' %t�1''icy ✓'� f Street Address/ State Road/ Lot #(s) �y
f/A, " State ZIP / ��r�if✓� L Y-/� /mod
Fax # ( Subdivision -51<"GLl�ei1�
zed Agent _ j �i`i' Gj City ��(/% /l�i>/�?; ��"I ZIP 7
❑ CW _ EW PTA DES �_ PTS Phone # ( ) r River Basin c•. <'%/.
❑ OEA HHF ❑ IH ❑ UBA N/A Adj. Wtr. Body C //ems `. nat
❑ PWS: ❑ FC: `n
yes / no PNA (f!) no Crit.Hab. yes / no
Closest Maj. Wtr. Body
)f Project/ Activity
ock) length
m(s)
I �
pier(s)
ength - -
lG �mber
Riprap length
+g distance offshore 4-4
iax distance offshore
i
:hannel
ibic yards
,mp
use/ Boatlift
3ulldozing
ie Length
not sure yes no
i
gs: not sure yes no
rium: n/a yes no
yes no
i
Attached: yes no
h e by / 1"7 6 s 4:1 1
(Scale/
J
ing permit may be required byTP�ij I�y�yj^)���/ CAL N�KIIG�, ❑ See note on back regarding River Basin i

�,'�A RFT 7) APR
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis
Governor Director
192013
Dee Freeman
Secretary
AGENT AUTHORIZATION FORM
Date: / 2 I
Flame of Property Owner plying for Permit: Name of Authorized Agent for this project:
l A- �AAJ16C_ --5,Al R LEY
Duner's Mailing Address:
n_Atfr, NC
'hone Number
Agent's Mailing Address:
3 55 D ( TALI, Puts E C7—
Phone Number((//o
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or construct the following (activity):
_ _ I I IA/ , l li,l I
'or my property located at 4
is
b k./ Yx.w C,
6 q1 1,3 /3
Property Owner Sio4ature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to SAY t,vi a s; <-5<4 4C'�.�5 's
l / (Na of Property Owner)
property located at _ [� �,� �(J`� n l-. �v r1 i )f 7
n (Address, Lot, Block, Roa , etc.
on ; h �� Cr—'-lc , in 1 ) Af CJ N.C.
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatio
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)
-F-L OA
L_
C�£1NSTR�+ICT IVE't�„ TiM�e,lZ �
aU.,1 PCA,b /NL/N!= kd lTtf 2
�S• PRO A E2T°y` £� w N �t2S� �
/ ICECONNEC?` NEV VMP
C rt o N E-ll 6 .u.L x µrA L
i .
/OCo� �X/jT NCB 5Ct[rKHEAL`
KE"ivT� Ssf �JF'IIVA STE�E�V�
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 wai
the setback, you must initial the appropriate blank below.)
N� I do wish to waive the 15' setback requirement.
_ I do not wish to waive the 15' setback requirement.
Owner
:1<T�v1J-A-0 -y 2h C
EP ' t or Type N me
�F s U
ailing Address j
.Lctnm �
(Adjacent Property 9wfi-er Information)
ME

I hereby certify that I own property adjacent to _
prope� ocated at _y �� �GLiyl ✓; r�
/ rr c (Address,
on in
(Waterbody)
-,- <-� ,y i
pm of Property
I
V'�A i' G , N.C.
and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatioi
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
It✓ b C K
CAN STR utCT NE'h0 T /M eC-,fZ - ----
cl.�%E+EA�© lNL/NC ke/7�' p RE COaNECT NEA., AMP
/O(o' EXI57-/NCB 13uclK14EAD
13ut-K 4E-,4'�
KE'NT d- 5,43RINA 5 7 S
6 q a 5',L, /,A, - I ry"--' n"* P N
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 wail
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.
rty Owner 1 bon) (Adja It P operty Ow a 'Information)
w%gn�re 11 Signature/ I /
by) � �. V � � �+P �^ � �
or Type me Print Type Na
96 r'� /k1A bad P3 �Inf\t,uu cQ.
Address Mail b Address

i■i

�� v�n vT c.caszai mg;.
3plicant:
ate:
Mabtltat Impact Computer Sheet
Permit #
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat 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
151
Dredge ❑ Fill ,( Both ❑ Other ❑
2 r 2
z/�
Dredge ❑ Fill [Both ❑ Other ❑
q��'
/ �L/'
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 ❑

OVERBECK MARINE CONSTRUCTION INC.
3506 TALL PINE CT
WILMINGTON, NC 28409
allm
A� DATE 66-46/531
/ /z 5 J�
- 1 $ yo -1:
_DOLLARS @ -=---
XV S ACH RT 061000104I/
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