61568D - Zwack

-�CAMA / u DREDGE & FILL /�A
3ENERAL PERMIT J"`G Previous permit#
Aew ❑Modification ❑Complete Reissue JPartial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources Date.
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 124
EfKules attached.
it Name kj.,e,-el/e Project Location: County
i 9/ �lvs�ii l�sjr/fli'-/ , Street Address/ State Road/ Lot #(s)
%Y sri r State JL' ZIP 2e-yl 11'e /l iA 1
" / V/,Z Fax # (/ ) •"'—"' Subdivision "
zed Agent 1�lx / 9/,/ "tr6 &I City l/1// �rhi/�iy hT ZIP �sy
❑ CW 'P-EW !�-PYA ES C PTS Phone # River Basin l�
❑ OEA ❑ HHF J IH ❑ UBA ❑ N/A Adj. Wtr.. Body nat
❑ PWS: ❑FC: /� r
yes /; n'W PNA yes / Crit.Hab. yes / no Closest Maj. Wtr. Body
d Project/ Activity
IX e-1
�■■I
M■!7■■■/ I
nor. Hs
IIMVIUMI
ibic yards
mp j
use/,K..tlif
3ulldozing
ie Length --- -
not sure yes o x.
gs: not sure yes
; r
rium: n/a yes o
yes Attached: yes
ing permit may be required by: N9 '/''
1
(Scale: /
❑ See note on back regarding River Basin
l

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
AGENT AUTHORIZATION FORM
)ate: '� 0 a 013
Jame of Property, Owner Applying for Permit:
Mailing Addsls�
'hone Number:
Dee Fr
Se
certify that I have authorized (agent) L&AT'2 R'( HT ,rl. 114o d -c, � "M -4, 0to act on my
)ehalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
;onstruct(activity) �,Lfi-ALt Q.I�;,) ��� God �. } �P(Lcfcr�-
at (my property located at)
RECEIVED
DCM WILMINGTON, N
MAR 202013
rhis certification is valid thru (d te)

,-,—d Af/" L-r�
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to
(N a of Property Owner)
property iocatea at
(Lot, Block, Road, etc.)
in
on C I '
,N.C.
Waterbody) (Town an or County)
Applicant's phon #: �1 � �� �� Mailing Address: �.�
rie 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 (l S1 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
V I do wish to waive that setback requirement.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
9>,f J n,�k Yl W (ti
Mailing Address n/C y2 V
City/State/Lip
RECEIVED
DCM WILMINGTON, N
MAR 202013
(Riparian Property Owner Information)
An —
Signature
Print or Tvrwe 1`amr.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PiER/MOORIIVG PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to
property ioc:atea at
on
e 9T Property Owner)
dnlQ.
(Lot, Block, Road, etc.
(Town and/or County)
Applicant's phone #: ,5 Mailing Address
10--
,-!S� (2-e
N.C.
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 (1 S) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
1 I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To he filled in by individual proposing development)
DCM WILMINGTON,
MAR 2
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) o sj��,ib l ,,k (Y,6 n
Mailing Address Sig Lure
City/State/Zip / _ Print or Tvne 1�amP

par Ian
aback
S
4.
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X
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to
X
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a
a
a
Pages Creek
12 ft.
�3 ! 32 ft. \
R1pa
Setb,
Deck
Rnmp
F1oatlrb ©at
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au
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RECEIVED
INGTON, NC
Designed By: d er Marine Construction,
Addrej$ARP�,j
W mtnot,n. NC 28402
Telephone: [phone]
FQx: 910 799-3402

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
)plicant: / �,r�� Zaqrep? �tgee Permit #: 0115-
3/2c/i 3
?scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
ibitat Name
w
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternimpacts)
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 ❑ Other Pf
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 ❑

BOATZRIGHT INC. 1538
817 BERWYN RD. 910-795-0228
WILMINGTON, NC 28409 /!,� � � � � O I
iJIY� 66.30/531
DATE 356
� ?U h�S DOLLARS
itizens
is.com
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