60665D - Dorman

1
',LAMA / DREDGE & FILL NO. 60
GENERAL PERMIT ' ' .. Previous permit#
'New ❑Modification Complete Reissue :Partial Reissue Date previous permit issued ��
orized 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
!�, ❑ Rues attached.
nt Name i1 l)ba°/✓ (1/'(t -r,)v le MA J Project Location: County
s -F_i5'"l Z'1 Street Address/ State Road/ Lot #(s)
ZP)_ Im State tj4'ZIP ?_.
( ► j�)37. ��%� Fax # () Subdivision
�O
Ized Agent ;'^y l City C7V ' ('d ZIP Zt'cs
Cw EW �fit��A J ES I Prs Phone # ( ) River Basin
OEA - HHF _ IH UBA N/A
_ Adj. Wtr. Body G/(M,K _VwK! (nat
_ PWS: J FC: l
yes 0 PNA yes no Crit.Hab. yes no
Closest Maj. Wtr. Body /k
A Project/ Activity 1►� `j f a1190011
(Scale: W.
ock)length
v
i
m(s)
pier(s)
gt
umber
ad/ Riprap length
, S
U' • �'
vg distance offshore
}i
iax distance offshore
-�
:hannel
i"n
Ait
.ibic yards
ZIP- f
imp
uv ►+, ycrZ
Bulldozing
ne Length %- 25_-, I
not sure yes
gs: not sure yes
rium: n/a yes
yes no
Attached: ve
ing permit may be required by: / ❑ See not/)e on back regarding River Basin i
l

a

NCDENR
North Carolina Department of Environment and Natural Reo,,u„
Division of Coastal Management
iel F. Easley, Governor Charles S. Jones, Director
agreement
William G. Ross Jr., Se(
AMIn, is hereby authorized to act on my beha
(Printed Name of Agent)
,,r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to 1
c activities described in the attached sketch.
TION OF PROJECT:
law
ERTY OWNER MAii..iiw
3 4 D US Lia I t rj-h
PHONE NO. C h Q -
-ENT MAILING ADDRESS.
PHONE NO. _q/ 1) �3a % -7

N U I t(, SOIL INC, .
yto3Niln s,
,
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to NU VLr i 4' RU i h POY W is
(Name of Property Owner)
property located at _ L4 fail S }'
(Lot, Block, Road, etc.)
on DR ri ah in � n n& I OW Co u ri im , N.C.
(Waterbody) (ToVvn and/or County) J .
Applicant's phone [phone]TIq Mailing Address: OrU �11SiIGttl, On
S �
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 (15D from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
--L_ 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)
%Hoys u-)-, oU�h
Mailing Address
;l .iQ III I n _ A t om 11% 0 7 ^) /]
(Riparian Property Owner I formation)
Signature

11
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORIIVG PILVVGSBOATLIFTBOATSOUSE)
I hereby certify that I own property adjacent to "U uU i' 1' Q4! fh PO Y Y)'1W s
(Name of Property Owner)
property located at L4 L4 t cS
(Lot, Block, Road, etc.)
on C U n al S in m I Qw Co U h h , N.C.
(Waterbody) (To and/or County)
Applicant's phone #:!110 3a-7 3T Iq Mailing Address: - 6 n D►?a (`,011Sf7G1lG 0✓1
III L41
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 (Riparian Property Owner Information)
for Permit)
OOHO Vs
Mailing Address Signature
ty,win , NC, aR�3Q �,��� .� lam,' o C . , 4-.�

Permit #: L U l U 5-
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
)itat Name
0 W
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)
I FINAL Feet
{Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
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