62688D - Witmer

F ✓ N� 626
CANIA / 1-1DREDGE& FILL
RNERAL PERMIT Previous permit#
e previous permit issued
14ew ❑Modification [-]Complete Reissue El Partial Reissue Dat
zed by the State of North Carolina, Department of Environment and Natural Resources Ile 57 /� �/ ' 17
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC ules attached.
:Name
State /JC ZIPT
() Fax #
:d Agent fGhlletlClef-I KIVIV
CW ❑tW Q#TA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes /, no PNA �61 no
Project/ Activity
:k)length (5 X
(s) )5 "x ►S , Sx
ngth
tuber
d/ Riprap length
distance offshore
uc distance offshore
cannel
bic yards
np
ise/ Boatlift
lulldozing
t
X
ie Length
-_—
not sure
yes
gs: not sure
yes
r9l
,rium: n/a
yes
l�;'�--.
yes
C.
Crit.Hab. yes / no
1/
Project Location: County /(%f �-✓ ���'
Street Address/ State Road/ Lot #(s)
/6401 �- rrl' .
Subdivision A,
City % i�a4 ZIP
Phone # () River Basin
Adj. Wtr. Body ��r%�l ���e�/` na r
Closest Maj. Wtr. Body �rt���y� /4i e'V.rt
t
(Scale: ,
Attached: yes I o,
ling permit may be required by: A/ i"t �� • �t �I�� / �� See note on back regarding River Basin

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r RECEIVED
DCM WILMINGTON, NC
V' f
! �r 0 C T 3 1 2013
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Permit #: /n 2 01�g
le:
;cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
itat Name Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
Dredge ❑ Fill ❑ Both ❑ Other
iIIVV Dredge ❑ Fill ❑ Both ❑ Other
�G
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
--jDredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
COMPLETE•N
COMPLETE THIS SECTIONON DELIVERY
- ■ Complete items 1, 2, and 3. Also complete
A. Signature
item 4 if Restricted Delivery is desired.
, ❑ Agent
■ Print your name and address on the reverse
❑ Addressee
so that we can return the card to you.
1 e of elivery
■ Attach this card to the back of the mailpiece,
ttp�(Pr1ntRdNhme)
or on the front if space permits.
Is delivery address different from Item 1? ❑
1. Article Addressed to:
1%icnr �'res
If l!ES, entpo�delivery address below: ElI
�- pCT I I W3

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOP A PIER4I00RING PILI_.VGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to J, c� 's
-ame o operty Owner)
property located at % ,
(Lot, Bl9ck, Road, etc.)
on 'P, in t t I , N.C.
Oy�iterbody) 04wn and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
back a minimum distance of fifteen feet (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.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposin; development)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writ
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Est. Wilmington, NC
DCM representatives can also be contacted at [phone].
1
011 No response is considered the same as no obiection if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
Mailing Address
Citv/Sbfte/Zip
(Riparian Property Owner Information)

��A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
arly Eaves Perdue James H. Gregson
ernor Director
AGENT AUTHORIZATION FORM
Date:
i of Property Owner Applying for Permit:
ier's Mailing Address
J„ AL
Al
)ne Pumber (`�/• )3�6 Z9h
Dee Freeman
Secretary
Name of Authorized Agent for
afor this project:
�SnL,I-/A,pl1c�a a t 6( 'S4"UC-7?
Agent's Mailing Address:
G5a Tom LP /2
l V� icvl SrTI C
�i k _ ocy
Phone Number( 1(c) ,S-3 8-- mot' 77 -3-2�
:rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
ocK w k-HA S i � Aa'^,�k e�i-
y property located) at
its certification is valid thru (date)
Property Owner Signature Date
/k
RECEIVED
DCM WILMINGTON, NC
0 C T 3 12013