59197D - Carroll

CAMA / 'J DREDGE & FILL
59'
"ENERAL PERMIT
Previous permit# x /h
New —'Modification -]Complete Reissue
LPartial Reissue Date previous permit issued
'nzed 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
IL� es poached.
it Name...
-
Project Location: County�
/
DV
Street Address/ State Road/ Lot # ;)
5/ State�� ZIP
`Fax # O
Subdivision
:ed Agent 11r r
City J ZIP zy�
❑ Cw �Jisw D PTA QES ❑ PTs
Phone # ( j"�'� River Basin
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
Adj. Wtr. Body -1MJ 1 ✓� 'at
Closest Maj. Wtr. Body
ye Uno PNA yes /09)� Crit.Hab.
yes /F�
f Project/ Activity
ick) length
'ngth
tuber
'rap lengtf / 00
'stance offshore
ax distance offshore
hannel
bic yards
np
'se/ Boatlift
ulldozing _
e Length Gy[/
not sure yes no
s: not sure yes
i
ium: n/a
kttached: ,.!y"��y no h yes
yes .,
(Scale: r /
ng permit may be required by:,� % �h! El note on back regarding River Basin ri
_

Aw,,Ili
li.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
i F. Easley. Governor Charles S. Jones. Director
Autnorizea Agent Consent Agreement
� �,o�s-�ry c.1� � ►�
wi►li rr G. Ross Jr.. Se(
is hereby authorized to act on my beh�
(Printed Name of Aaentl
r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to
activities describea in the attached sketch.
nON OF PROJECT:
=RTY OWNER MAILING ADDRESS:
PHONE NO. Q/ D ✓ki � 37ov,
7RIZED AGENT MAILING ADDRESS:
r-h n- (' P,4' VCJ -
U cr6L A
2
PHONE NO.

ADJACENT RIPARIAN PR &W/�WNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to0qYQUaV1bV r rD s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.) nn J
on N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:9 (0 32Mailing Address: I V I YC41 Yt 1it t-f')
S ru6 �r rn.� tiz ZO q(it)
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'Aish to waive
t� 142 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 (Riparian Property Owner Information)
for Permit)
W &x x(o
Mailing Address Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Wo r o id
T/,(w i w Co r 1p i ks
(Name of Pi4pertv Owner)
property located at
2q D&v-- un Sneuals
(Lot, Block, Road, etc.)
on . in i�Y1�Cb Vv (a)0 , N.C.
(W aterbody) (Town and/or ounty)
4Pt7�111,)Ll C417V" 7oki
Applicant's phone #: 3;n375-Mailing Address: / V5- V ifs I nla u,7
StEctds KyyV /Ut 2311[QU
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 proposing development)
(Information for Property Owner Applying
for Permit)
Po Bu aoln
Mailing Address
(Riparian Property Owner Information)
Signature
!::�nnnrk t�,.„ . rN --JQ�/ltnfl
v

`
z8

ite: % I f 7i
/ " t- Z�
Permit #: -5� / g
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat 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/o
temp impact
amount)
G� �✓
Dredge ❑ Fill Both ❑ Other ❑
Leo
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3
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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 ❑