59153D - Gauches

-CAMA / ❑ DREDGE & FILL
.ENERAL PERMIT
2New •❑Modification ❑Complete Reissue
59
Previous permit #
❑Partial Reissue Date previous permit issued
rizeld by the State of North Carolina, Department of Environment and Natural Resources --oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC % 4 / / OZ)
t . , f^ ❑ es attached.
it Name ice' % !, (J I'� �-#, U ohe5 Project Location: County V!/.-tiL
63 {') ���' �� Joe.?, Street Address/ State Road/ Lot #(s)
,� r
State_ t�9 ZIP A G ° % 4" &
# ( ) Subdivisi n 90 0 � V,
ted Agent � Y� �'� City S .de -A ZIP
❑ CW ❑ EW ❑ PTA 1PS ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
El PWS: El FC: Adj. Wtr. Body w I k nat
yes V PNA 0g7"" Crit.Hab. yes / no Closest Maj. Wtr. Body q� a ! <1
f Project/ Activity (An STif /Z r e-�yv..u- t li✓� ��
:ngth
ember
{�Nprap length 7 j /
g distance offshore
ax distance offshore_ "'
(Scale:
Attached:
yes
ling permit may be requl/Jed by: ❑/ See note on back re arding River Basin

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date Y /2'
Name of Property Owner Applying for Permit:
Mailing Address:
//d 4C !/W
-,j/-
/4/ (:;L CY
I certify that I have authorized (agent) '-,JO ,*"7- ��� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)[) t-- I /v; V-- c(oC u- p e-r wu
at (my property located at)
This certification is valid thru /` r (date)
Property Owner Signature
Date

5 Bedroom residE
1.0 LIAR
450 sq ft; 150 Iin(
2 lines @ 75 ' Poh
25% Reductic
12"-18" Trench Bc
12" will require b"
System must run
Repair Area
.4 LTAR
Low Pressure Pipe
4 lines @ 75"
1500 sq feet
20'x75'
p SOIL /S s
C 1
`rc�
nd
undary
-
50' S pia
=:
bedroom
resident
80,
a
10
e 162
Shallow

'ante of Propim 0wrrer.
Address of Prop": _. 4 n �- % �/ � ! X
of Street #. S+seet or RoW, Cay & Co:!:;ty)
fak,3 rrt phone #: l �j % Mailing Add p;
r ;reraiq Ag*j,} that own property adjacent to the above referenced property. The- individttat
applying for Mis pe nit I'm desctiW to me as shown on the attacheri drdwing. ttae devekwinent
thW are propming. A de&%ivton or Wlttt must be peowdo whit JklIft.
t ;r,: ; r no of sections to this propf? L i have objections to this proposai.
rr y ou havo objeCdOM to What is b6f/19PiiP )034 dr "j w mtW noW.&bo Vision of CaasW A1M► gJafn M
iDC ) in wtrfP;"rg i Nhin 10 days of t x*W of this nagm COMM &rfennatkm ha'r 9M OMM 14
gveiiabte in w,ww-nceosstatmangemwitaQHca�drm.Atm or by ealfing f4884RC.OAST. No
rtspons4s is oxtsicier +d the sa ine as no 08MEt2n if you hove been nodfied by CoM ied Moil,
WAIVER MEC ON
i urdefsond that a pier, dock, mrx)nng pilings: breakwater, boathouse. or rift must be set back a
rninirmur dint�ince of 15' from my area of ripari2n access unless waived by tie. (if you wish to
waive t;,=, seer, yeu Must JnMl the appropriate blank below.)
i do wish to waive the 1 a' setback requirement.
f do mt wish to waive the 15' set &* requirement.
{i�t;o�erty-�t3vvrter tt�ottnatian}
rWiK 1. �,:7
jnJ �,�.� ir1r►� �i rev `��-<� -,�r-
?4e4ny Addtw8,
TslGyAw re N;-,, nber
)XO
(tRia jt Prolmrtty Owner information)
--.- � )s 4Y)V-
s

T—A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Govemor James H. Gregson, Director Dee Freeman, Secretary
Date �I— U / L
Name of Property Owner Applying for Permit:
C"C 1
Mailing Address:
I certify that I have authorized (agent) —1/'lt /' �G (/ �, h r/ to act on my
behalf, for the purpose of applying for a d obtaining all LAMA Permits necessary to
install or construct (activity) tJ
at (my property located at)
✓ ` / - / ?
This certification is valid thrn (date)

�rc7•dfr� �I..l�hft'(
0
y
L/

I ,
plicant:
vG A ff
Permit #: 51 /S-7
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
Atat 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 sfxn
3 5-00
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 0 Fill ❑ Both ❑ Other ❑