61600D - Wells

CAMA / DREDGE & FILL
EN ERAL PERMIT Previous permit #
New Modification ❑Complete Reissue 'Partial 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 �� a a c )
ules attached.
nt Name I`J(PNIAA 1 S Project Location: County /tw
o -G- er%1 75 Street Address/ State Road/ Lot #(s)
_. State Nt zip Z
(_ ) r Fax # ( ) Subdivision
ized Agent __ CityJ A 4-:
d cW EW PTA Es PTS Phone # ( ) River Basin G*24
OEA HHF IH UBA ❑ N/A
PWS: FC:
Adj. Wtr. Body NC <-.FK nat,
_
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body /
:A Project/ Activity
(Scale:
lock) length
•m(s)
pier(s)
length
lumber
mcl/ prep length
tvg distance offshc
nax distance offsh
channel
ubic yards_
amp
)use/ Boatlift
Bulldozing
ine Length 7 G
not sure
igs: not sure
xium: n/a
Attached:
11
Jing permit may be required by:
p6N'JLX Cam,
❑ See note on back regarding River Basin
pll-s i
/h./N.'7.7.,^I C
AJ' -7!1
l i ti_. ,e_ r %ami"'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
� 1n/e s '
I hereby certify that I own property adjacent to tI I S
property located at 1 2 V(Name of Property Owner)
? 7 � `"'
(Address, Lot, glock Road, etc.)
on NE r "*r in f�ti: �a�.�� N.C.
-�(Waterbody) (City/To n 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 till in description below or attach a site drawing)
Set af%Ched drawiv%-o
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature Signature
W ' r�"�, Wp i�S kt.�kr\R� t'k l km,ti\�XNS
Print or Type Name Print or Type Name
3 I I S nl /; Ywv. 133 12•� Cyl� _ `�cii� C

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to W-1 rt h kh 115 's
(Name of Property Owner)
property located at f 21% 77 !a S N w4, // i S
(Address, Lot, Block, R ad, etc.)
on A) CtApe k , in , N.C.
(Waterbody)� (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
S -e ,+hi-c ee- d a i
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
In%; -+% IJdl5
Print or Type Name
311s,NC 133 N�,�.
--
(Adjacent Property Owner' Information)
z
Signature
L.,G RAc� (�!/� �i •J s
Print or Type Name
3( 'Ave-

i
r
_tt p 1 tons�s� r_ p� tonZr"e
-------- -pro L1 R 1►ti�1-RCJtlMc-K�C �]+L.t�C� Y L1[�.G tr_I�
to etuc-d id froM /Kh44�1 i
i +
�14�jf
i L
D,r+ +o
cre4�t evthslaft-

wilaw w wells 30� 299
3115,Ve-May 133
Paint, Ne 28457
5-29-J3
DATE
PAY TO THE 2
ORDER OF ni�
DOLLARS
z 1rwA by 1Grm Prin! , r. J.r and linnnnl,. Hnl Liuirn�l;dnl 6,{r•�n hdrA Il :rr rf prr�. �H. ;
�i First Citizens �p
Bank
(fr J400--Y
FORo��,r� -re�e.ui Crrm.t
1:0 5 3 L00 3001:0000 9 6 28 6 3
10no 00 299

pplicant: VV KTH WO-L.S Permit#: W &GO
ate: 5/2-2/13
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet FINAL Feet
(Applied for.
(Anticipated final
(Applied for. (Anticipated final
bitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance disturbance.
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)
56
Dredge ❑ Fill E"oth El Other El'
4-c�$
�Cg
/ -76 / /4o
Dredge ❑ Fill Q�Both El Other El
0
V&
1.
I "
1 7(0
/
1 <^-7b
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 ❑