57457D - Surf

iCAMA / DREDGE & FILL
GENERAL PERMIT
fAG Previous permit#
]New .Modification El Complete Reissue El Partial Reissue
Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources c ! / (JO
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
i
it Name r'\ G U►' -(
❑ Rules attached.
Project Location: CountyOCA UU.}
tM.: t ,l V` Ck .I
Street Address/ State Road/ Lot #(s)
t) J
i : t —State N t✓ ZIP ,,rq
i`z Fax # ( )
Subdivision
zed Agent UV�'�t AS5 i
City S L) / C4 ZIP 2
1 ❑ CW ©PTAS ❑ PTS
Phone # ( ) "— River Basin CO
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
Adj. Wtr. Body CQr1a � i r1 � gnat �
El Pws: ❑ FC:
Closest Maj. Wtr. Body✓✓It �y��
yes no PNA yes / no Crit.Hab. yes
f Project/ Activity
)ck) length
mgth
ember
tdA%prap length 115,
,g distance offshore �—
ax distance offshore
hannel
ibic yards
mp
use/ Boatlift
lulldozing
ie Length
1
not sure
yes no
;s: not sure
yes no
rium: n/a
yes
yes no
Attached:
yes no
ing permit may be requirec
J�l'k rtfJAinir►a v\'kll CA1.
o f C- a -AA a-1
(Scale: 1 1 f

a
- e Proper nonce
�3er - �;Ou as an era, z 'Pa 'art
a�vac-&nz T, I PMD,-MY owner to the individual o,
proceduresIt a�piicaticn require tnar applicants provide the Division c
Coa--La-i'Manaeemen-4 con- "rm arion, that a %&Tircen sracemem has been obtained sinned by the adiacenr riparian propercy owa
-,hST he--.; ';-1a,.;-- no oPiectior, i0 dhe proposed vv-ork or ma-L tha e dmiace-
mparian properry o-.�.rners 1--ave been no-difie
�em"-ed mz G7 � e proposed work. Ofte- -e e fo-m-Lq are submined to the adjacent riparian propem, owner5 by a -.sari
.17m '[Ci- -3T.',-ner 'n-�:,,i;duals mine as an authorize aggenr on behalf of the appiicanT.
C
=C' _-- --5-2-z .7 7 -, C! o u by -he follo-AAng- -in dividua; or company designated b-y- the appReantr as ar,
ce-n-2r i
1 1 kn a 1- o r -z, rmn i -L:
i-I — — tr- — - %Lk�! '-;I C- —.zL -�.. creel Or Road
and C*ount%
U.! a. groper adiac-mro -rhe above -referenced propern--. The individual applying 'for this pern
rl th - anac ed draw; azei % oc;mert :hey are proposing. A description or
n n a ml - I drawin
orn-vided with rill_ 1'errer.
no obiections to this proposai.
being proposed. please Jrile the Division of Coastal -!Ianager,aent 1y
o A "j m -- n a -t o r. 'C :1 9 4 0 5 o r c a cuss 9
j- 196-72,14 within 10 days ofreceipt -of ihis no c
•'dere � t,'-,r- sa.me as no objec-i on notified by Cei-tified Mail
o p cp as �� �i s c o ns i ia Ll 1 you have been noti
fir.," A -7 E R S E. �-- 77 0 N-
g piliim. breazi-L-Warer. boat house Or boat Hift rmasr be set back
:171:7i Z1;2�. pie-r' cioc,�L moorincr
11 aXGMIM-121r--2 Of ?L'Par�aDaccess
uless W ived b-v me. (If vou wish to m-akve th,
opriate biank beWw,', vGX-* ii IUST 4a:rtla1 the mar
:rytD M Me 1 se-'bac�-
C setback requ'
L ro wa ve tlVizli i 7 IremenT.
I A / %�e��v s
Date

4
tjk U
as 'aln
-De c. L 'De� ''d
Procedwres require 'fist appiicanrs provide the D:v
1-0nee OV, thy adiiac-,ni: _-,-oayjEr.. ;;7acerc
MIEZ a ••i aen, 3memem !wz been obtai nee 31
C 7C.. Lwc.'oSac r,..- 7.n at
e adiacejz riLaria,-, e !)'er
C X-en thptse forims a:et submia. .1-0 the ad:acen[
or h i, a. Mng as all. au-morized ag:eni on behaif ol- the appiicani.
G he applicer.-, c.s -:z
77
!_A87e
V
o-, oadl,
p rc pez—;.v andjace-n- 7 adove-re—rp:licled ro, e ­;. 7' indlividualapllv`nefb-
-.0 D 0 r7 I.ne i
--r -hey are or oos,n. A dtscl-:,jr:ion or c
7! '­M-LtO
?c d,-, e q.
7 '_
!7 0
LF
fl, d
J1 MUcT J= Sn-
z Q
Uil S%� 73U 14T.a �G `,Vz.
4. _��Sn lie- 7, 1
--back -e,QPremem.,.
3) 1

-ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
in your Habitat code sheet.
DISTURB TYPE
�t Name Choose One
Dredge ❑ Fill lam° Both ❑ Other ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
and/or ternp
temp impacts)
impact amount)
2,3 cC7
Z3oo'
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
Disturbance
disturbance.
total includes
Excludes any
any anticipated
restoration and/or
restoration or
temp impact
temp impacts)
amount)
Dredge LJ Fill LJ 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 11

MONEY ORDER
GP " s'7
C-CHECK #1
6432 04/02/13
North
MN
328252743
M.O.#328252743
:S;::7.->ppDOLS(pQCTS
TWO HUNDRED AND 00/100 DOLLARS
NOT VALID OVER FIVE HUNDRED DOLLARS I$500.00
ruR Hens nnon[s9EFf �✓ HIN�. /�'.C..L" LI'r1:....._..... _ .. .... __...