59151D - Fussell

I.
CAMA / ' l DREDGE & FILL 59,
3ENERAL PERMIT Previous permit#
Ne�v ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued -'
rized by the State of North Carolina, Department of Environment and Natural Resources 7
;oastal Resources Commission in an area of environmental concern �ursuant to 15A NCAC
❑ Rul attached.
t Name -UV C F-05''5i�LL Project Location: County �Is7;A/
`7119 it-4 5 -.
y14,4-- G t StateVC- ZIP
Street Address/ State Road/ Lot #(s)
�4 y7.) Fax # ( )
Subdivision
:ed Agent 5' 444I'
0r"
City �7�/�C/ Tile
ZIP
G CW ,i6EW
PTA L:•ES J PTS
Phone # ( ) S4 "t--
River Basin 7 r■
❑ OEA ❑ HHF
--lH ❑ UBA J N/A
Adj. Wtr. Body G41147
%%/Lt�Gt/ na t
❑ Pws:
❑FC:
yes /t:% PNA
yes (no� Crit.Hab. yes / no
Closest Maj. Wtr. Body v
f Project/ Activity
(Scale:
ck) length_
1(s) —
ier(s) —
ngth
tuber
'prap length S
distance offshore
uc distance offshore
cannel
bic yards
np
ise/ Boatlift
ulldozing
e Length _
not sure yes
o"
s: not sure yes
ium: n/a yes
yes
%ttached: yes
no
ng permit may be required by: )�' / Gl ❑ See note on back regarding River Basin n
_ LL

NCDENR
-S
Division of Coastal -Management
Charles S. Jones. Director
Authorized Agent Consent Agreement
ac* cn� miy b
!
ar,,, CAMA peiw:vs) reau;reci 'or 4�— prim, ted
-.
de5cr;"-- In L 'I-- atlached swet&.
—_
)N OF PROjECT-.
'TY OWNER MAILING ADDRESS:
PHONE NO
Ak— 10,
ZIZED AGENT MAILING ADDRESS:
PHONE NO

ADJACENT RIPARIAN PROPERTY OWNER STATEMEN 1
(FOR A PIERIMOORIATG PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to g k u— Pq' 5l— Is
(Name of Property Owner)
?roperty located at -),is TIA t o
(Lot, Block, Road, etc.)
on CFAF� L — in ,�i� CAI T'i'? N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:CA ICE 3 56 --03tO Mailing Address: X 0• 3`I __—
x ISIA . C.-TLI 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 (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)
Mailing Address Signature

ADJACENT RIPARIAN PROPERTY OWNER STA1'EMJK N*1
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to kwL loos. Eps L- s
(Name of Property Owner)
.property located at l Il CA
(Lot, Block, Road, etc.)
Dn L. , in J wr GI I: , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:t 1AW -330 '43►0 Mailing Address:,X Po'
x S� C.-
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.)
[D I do not wish to waive
k 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)
x PZ Ltf ��3� tJ' S-r
Mailing Address
------------------------------------------------------ ----
(Riparian Property Owner Information)
Signature
n � k- , k

` rJsplicant: ba f� ��7,1/ Permit #:
3
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
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 El Fill ❑ Both [I Other
01
�
�ryZO
Dredge ❑ Fill oth ❑ Other ❑
SS
d
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 ❑

■ 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 mail' piece,
or on the front if space permits.
1. Article Addressed to:
J(D�(-(- k� 1�
C,Wft to Nrc. a
A. Signature
nn ,,�� ❑ Agent
X�}'ftL�„ � �-- ❑Addressee
B/§ieceivep by (Printed Name) I C. Date of Delivery
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 7010 1060 0000 8471 1026
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02401-11540
■ 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
C UUJLo
nk v f vim- B � t� �' m m � i►�3at�
LQS I to
A. Signature v`
� /y ❑Agent
X 4/%i //? Addressee
Received by (Prnted N+met f C. Dafe of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No ;
U P`;'
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 7010 1060 0000 8471 1019
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540