62670D - Stone

a
C'AMA 7 DREDGE &FILL
3hENERAL 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 , y
Coastal Resources Commissiqn in an area of environmental concern pursuant to 15A NCAC N
Rules attached.
nt Name ' Project Location: County
s Street Address/ State Road/ Lot #(s)
Stag_ ZIP_ GlG �A 1
)' -� ax # ( ) Subdivision v QO S ✓1
S )GG
zed Agent (; City \ v i , U ZIP -0 -! 6
j CW EW PTA ❑ ES ❑ PTS Phone # ',-A (a ) , 0 L61C River Basin t 11'1f\
OEA HHF IH ❑ USA ❑ N/A Adj. Wtr. Body F+c nat
PWS: 1 FC: Ono 1/yes / no PNA yes / no Crit.Hab. yesClosest Maj. Wtr. Body Y
od Project/ Activity
amp
)use/ Boatlift
Balldo ing
X
- Attached: yes no �r'
ling permit may be required by: &vn5X/,nc.-L GVK ❑ See note on back regarding River Basin
.d

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: %40-" Permit #:
Date: / 1
6z-(�qlcl D
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
found in your Habitat code sheet.
Habitat 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 fin;
disturbance.
Excludes any
restoration ands
temp impact
amount)
_ ,
6 �/`�
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

& BULKHEADS
DROTHY
ERS NCDLCLDEN 5202642''�' _
342-9732
CHIMNEY RD.
NC 28462
Bank
c2v-;�c u
hl 1 D
000 I s ? S
29 6951203 5439
O Shield"'
DATE �
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I
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TAr t n

i3-280T 1fl:82 From. � Toc9g29BH�
NOM Cao*w Depeltmdof Envowwram are# Natuai fteawmes
Oh bW" of COWW fi m9pssnant
dad F_ Ea fty. GWAKW .ice K Awpmn, Dkscks van G R
Ai Qf Agow* Corm rt Agfaf11@t-d",
C- is hwety au#xrized to oct an
4 . Miw+�+afNp�rb
x�d!!r tq trbt0111 C.J1M� pe�sj �equfad % titer pt+opett� �S10d below, T`t�e auttwiiT.a+tion i:t G
in file ladled skeioh.
fCATf!!!i OF PROJECT;

U-03-2987 10:02 From: To:8429h306
J htlrt_� � �ll.l. ..► � a # � � �
�. "�1.: i. � � � � i � i r � �\ � � 4 �%�� i a ilk ►��, � � � � � �l
The purpose of this form is to provide proper notice to you as an ad accm riparian property owner to the individual or
individuals listed below, 'IM CAMA General Permit application pr..�s require that applic4m provide tht Divas
Coastal Manotgtmaant COORUauion that a Wdaen statement has boat obmined signori by die adjacent ri xwm property
indicating that they have no objection to the proposed work of that the adjawnit riprrian property owners have been 0
by certified mail of the proposed work. Often time forms ore suWated to the adjacent riparian property owners by e
contractor or other individuals acting as an audwrized agent on bahaltof the appliont.
Thh form eras sent to you by the following ladivi anal or company de*nated by the applicant as as
authoring agent
Authorized
- 30�/
Date
Name of individual Applying For Permit �` �f- S7`d R 'L-
Address of Property. , lS(00g W%
( Lot or Street W, laver or
(City and
l hereby certify that 1 own property adjacent to the above-mferenced pmpetty. The individual applying for I
has described to me as shown on the att$ched drawing the development they tare proposing. A descripoon o
with dimensions, should be provided with this letter,
t have no objections to this proposal.
If "you have objections to what is being proposed. please write the Division of Coastal Manage
Cardinal Drive Extension, W'1i miaagton. SIC 28405 or call 910.79&7215 within 10 days of receipt of i
No respame is considered the same as no objection if you have been aotitied by Certified Mail -
WAIVER SECTION
t understand that a pier, dock. mooring piling% breakwater. boat house or boast 1111 must be
mlaimurb distance of is, from my area of riparian access; - uaakse waived by me. (U you wish u
setback, you must initial the appropriate blank below.)
l do wish to waive the 1 S' satimck requirement.
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