61555D - Williams

I4AM'A / ❑ DREDGE & FILL 11t6
.ENERAL PERMIT Previous permit#
INew ;Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources I ZL)u
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
,,
-� jes attached.
it Name �� WI i c it Project Location: County An LLt-
2-13
'' tt a� Street Address/ State Road/ Lot #(s)
t�f ( #i ---__-- State ZIP 1 ?JZ. J ( i,ya V al
l
Fax # ( ) Subdivision N
red ggent�{ �:C; j� \1`5�1'i'1G�"t E� City ZIP lG
❑ CW EW ] PTA ❑ ES El Mine # ( ) ' • l River Basin
❑ OEA ❑ HHF -- IH UBA ❑ N/A Adj. Wtr. Body W (nat
❑ ❑FC: �
yes no PNA yes / no Crit.Hab. yes / po Closest Maj. Wtr. Body 1/VyU
f Project/ Activity
)ck) length
n(s)
>ier(s)
angth
ember
Ld/ Riprap length
g distance offshore _
ax distance offshore
hannel
bic yards
mp ---
ise/ Boatlift
to do ing —
, A y x 11� _-
N
ie Length
not sure yes no
r_
;s: not sure yes i
rium: �n/a yes no {
yes no
Attached: yes no
ing permit mayberequired by:
—I I
nf; n._J All .1 L
(Scale: -
I
�G l ��l • ❑ See note on back regarding River Basin i

T. FARMER 4363
4 SERVICES 2 66-112/531
-2725
,DAM RD SW �J
!, NC 28470-5657 /
r

Applicant:a-�—
Date:
Permit #:
(� 195 Sty
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
'abitat 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)
bw Dredge ❑ Fill ❑ Both ❑ Other
1
I
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 ❑
`-�X3o- ao

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
McCrory Braxton C. Davis
vernor Director
John E. Skvarla, I
Secretary
AGENT AUTHORIZATION FORM
Date: ! ' " 15
prof Property Owner Applying for Permit: Name of Authorized Agent for this project:
;r's Mailing Add rest:
e Number (9) 7 § 3
Agent's Mailing Address:
cjc.
v
Phone Number (%0)
fy that I have authorized the agent listed above to act on my behalf, for the purpose of applying
id obtaining all CAMA Permits necessary to install or construct the following (activity):
,y property located at
:ertification is valid thru (date)
Property Owner Signature
Date

�> DIVISION OF COASTAL MANAGEMENT
rf - ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONAVAIVER F
I Name of Individual Applying For Permit:
Z.) 4 ---
1 /
Address of Property: A3 ( ca-At'i,� �7
(Lot or Street #, Street or Road)
(City and County)
hereby ceruty that I own property adjacent to the above -re eren ced property. The in tvi
applying for this permit has described to.me as shown on the attached drawing the development tl
Are proposing. A description or drawing, with dimensions, should be provided with this letter
0, I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa:
Management, 127 `cardinal Drive Extension, Wilmington,. tiC 28405 or call 910-796-7
within 10 days'of receipt of this notice. No response is considered the same as no.objectio
you have been notified by Certified Mail.
WAIVER SECTION!
I understand that a pier, dock, mooring pilings, break- tiYater, boat house or boat lift must b,
belt a minimum distance of 15' from my area of riparian access - unless waived by me. (If
wish to Nvaive the.setback,-you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 1 5' setback requirement.
n �
Sign Name ate
/y
AM- Ak

- PV DIVISION OF COASTAL MANAGEMENT
�' ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: : � %
A�Y� ddress of Pro e (�
P
(Lot or Street #, Street or Road)
(City and County)
"Kr7JW.SwIcJa
hereby certify that 1 own property adjacent to the above -referenced property. The indivii
applying for this permit has described to.me as sho%vn on the attached drawing the development
are proposing. A de cription or drawing; with dimensions, should be provided with this lette
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co;
Management, 127 'Cardinal Drive Extension, Wilmington, INC 28403 or call 910-796
within 10 days'of receipt of this notice. No response is considered the same as no.objecti
you have been notified by Certified Mail.
WAIVER: SECTION
I understand that a pier, dock, mooring pilings, breakm,nter, boat house or boat lift must i
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (I
wish to «--aive the.setback,,you must initial the appropriate blank below.)
L I do wish to wane the 1 5' setback requirement.
q
I do not wish to waive the 1 5' setback requirement.
FA
Signl,1am'e - Date
XTI-WA

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