62538D - Wyche

:AMA / ❑DREDGE &FILL
ENERAL PERMIT
lew ❑Modification ❑Complete Reissue ❑Partial Reissue
ad by the State of North Carolina, Department of Environment and Natural Resources
istal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Jame
❑ CW
❑ OEA
❑ PWS:
s
N: 62E
Previous permit #
Date previous permit issued —6�'
I .aa)
i Rules a hed.
y EW -�J PTA
D HHF - IH
❑ FC:
PNA yes,
'roject/ Activity
:h
,er
2iprap length
istance offshore
iistance offshore
nel
.ength
not sure yes
not sure yes no
n: n/a yes no
yes /n0
I
❑ ES ❑ PTS
UBA ❑ N/A
Crit.Hab. yes no
r
h v' Z7 / y
Project Location: County Za��.fit
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
River Basin
Adj. Wtr. Body 10 H na
Closest Maj. Wtr. Body '� y
(Scale: /ice ;
permit may be required by:
► _ /ti
riLi+ El See note on back regarding River Basin�r/t

:)licant: Permit #:
;cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
itat 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)
Dredge ❑ Fill ❑ Both ❑ Oth
Z
Z
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 ❑

RINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
AMPSTEAD, NC 28443
'e4iz
Bank of America
ACH R/T 053000196
5920
66-19/530 NC
58754
zz
$ y0©' a
DOLLARS U
4 ru z/O
'qv
AUTHORIZED SIGNATURE
00 59 20n■ i:0 5 3000 L 96i: 000661, ? 3811

I*0
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date '%/.'L /13
Name of Property Owner Applying for Permit:
eIvSA-
Mailing Address:
241.� AA- 2-74o 9
I certify that I have authorized (agent) 440 ip +G to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) /3,wr , -/.zr
at (my property located at) 1/2- C ifp�tlN�(� 6 t-yo !o
This certification is valid thru (date) _ /?/3l I i.s
F
Ce,
Property Owner Signature
�/2-r11-3
na+a

f,l Ic1 II
I I Z
/� I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to g 0Nyu C i a J y is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
� n �
on ,in o�'Stu( 1.)e4c(A / C�, ( ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: ?ep 1"I'la`y 4
n
I�aletxti,
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 / boadift / 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 proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
Mailing Address
------------- ------------------------------------------
(Ripar' n Property Owner Information)
i
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to s
(Name of Property(Owner)
property located at l �! ^ n L( 61 V 6P
(Lot, Block, Road, etc.) QQ
on N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: 1700 Mfl-Y '� 5 1
,r
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
1 do wish to waive that setback requirement.
------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
Signature

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
62o S-to 2r )e,P
bar Gta•�� Mc- 2 77/L
A. Sign ture `
X �� El Agent
��jC� ❑ Addressee
ceivq by (Printe C. Date of elivery
I pill'
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7011 2000 0002 2767 9903
(transfer from service /aj
PS Form 3811. February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
-!)`- (fe�14r( VO^ MvrraY 1V
V 0 $ _ R PLr K-wuY Dr.
G `(Abvro , NC a753q
A. Sig a ure
A. ,,,,�� ❑ Agent
f%W�t th '��j _ V ❑Addressee
B. Received by ( Printed Name) C. Date of Delivery
7-z&-L3
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
;KI Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes