59163D - Chamblis

Adj. Wtr.
Closest Maj. Wtr. Body •2rL";V OP -X0
CAMA / DREDGE & FILL ' ` CC!
5
GENERAL PERMIT Previous permit #
New _. Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources f �� r)
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 7#/ /
,�
❑ Rues attac
nt Name_
�' 4VU k1l C' Project Location: County "Zl.
s ._ ✓ - Street Address/ State Road/ Lot (s)
aril, _� State NC ZIPS'./`'' Y�—`�.-
S Z5�— ��
# Fax # O Subdivision
_ j
ized Agent �� �' City l '` I ZIP 2
d Cw EW ABTA , `,QfS PTs Phone # 65iZ� River Basin
OEA HHF ❑ IH ❑ UBA N/A
C PWS: ❑FC:
yes rn
g% PNA yes no Crit.Hab. yes
Project/ Activity
dock) length
,rm(s)
r pier(s)
i length
number
ead/ map len�gt /Ih /Ih
avg distance offshore
max distance offshore
channel
cubic yards
amp
ouse/ Boatlift
i Bulldozing
line Length 0_
not sure yE
ags: not sure yE
orium: n/a yE
s: YE
r Attached: ye
ding permit may b<
J

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to --fit Cha t44 f ee s
/ c (Name of Property Owner)
property located at %� 3 64 J�e,� ,
(Lot, Block, Road, etc.)
`
on ✓1 a I ..+o ql ,,.�,, , in ( , N.C.
(Waterbody) 1 (Town a or County)
Applicant's phone #: 61 �- 413 76G%Mailing Address: 6o.33
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
Ko-3 6 S+ r, e-4
Mailing Address
(Riparian Property Owneer�InformatioQ)
Sigriatute
-0 1 1 r, n► I 1_ k —
C. _P nA nil �Ctiiv

C

>> J
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Joc CI LI;7 bp 's
(Name of Property Owner)
property located at 0 3
(Lot, Block, Road, etc..)
II4in ��
on � nAil
(Waterbody) (Town and/or Co nty)
Applicant's phone #: bV7 Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
------------------------------------ -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
nn /
(Information for Property Owner Applying
for Permit)
603 3�"
Mailing Address
(Riparian Property Owner Information)
signature

( -t� �, ot I
if

icant: CWA-M p"G (S
3 - zk - iz-
Permit #: S '�-1 (63
:vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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 Other
'�j
�f
Dredge ❑ Fil Both ❑ Other ❑
37
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 0 Both ❑ Other ❑