59200D - Griffin

CAMA / _ DREDGE & FILL o ��
G E N RAL PERMIT Previous permit # ?
,New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_�7
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 i
/ ❑ Rules attached.
nt Name'"17` /n� {/`- Project Location: County {�ti- iv
-- State A16 ziPi%3
ized Agent �rx7g;`,l
,d CW EW PTA :� ES �� PTS
OEA HHF ; ❑ IH i� UBA LJ N/A
PWS: FC:
yes / no PNA yes / no Crit.Hab. yes ChD
Df Project/ Activity
lock) length
length
camber
aql/Riprap length_%
wg distance offshore
nax distance offshore
channel
:ubic yards
amp
>use/ Boatlift
Bu WOZ*_""1_
r^
!, f
ine Length
not sure yes no
igs: not sure yes no ti
>rium: n/a yes no
yes no
Attached: yes no
ling permit may be requires
Street Address/ State Road/ Lot #(s)
f � L L.i tit. � � (;� f ✓� i �.
Subdivision
City zip 8'`I
Phone # ( River Basin CIF
Adj. Wtr. Body a"O n (nat
Closest Maj. Wtr. Body TE>��+!��'
(Scale: i It

TX;wj
1
HCDEEIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
leverly Eaves Perdue Braxton C. Davis
)ovemor Director
Dee Freem
Secret,
AGENT AUTHORIZATION FORM
Date: h0412-
ime of Property Owner Applying for Permit: Name of Authorized Agent for this project:
' T7
mer's Mailing Address:
S
6��Sk ZY A16
one Number ((?I&- --
Agent's Mailing Address:
o2s7/ led,
dos N� C. .29y3
Phone Number(gl0) `�7/—.2euiA
;rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
,41efV & IkkagW a f /8Z o%lc Pain 1 k/
r my property located at /�Z OIQ�
s certification is valid thru (dat) O f Z
P operty O nature Date

k,-- ,d—de-i,vcy
/84
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ; fQ t� �'/j2 '5�: 's
(Na e of Property Owner)
property located at �� lil' / GI�1 lea.
(Lot, Block, Road, etc.)
on /dam. fl 6-ef , in f Di , N.C.
(Waterbody) (Tow and/or County)
Applicant's phone #: 36 al--221 � Mailing Address: g�sX4s 1 ' 4 fld f
1��rzl`elld . /,/
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)
GLD 96(1-K1yeW4)
---------------------------------------------------------
(Information for Property Owner Applying
for Permit)
LV
Mailing Address
,BGfL�(l��i4�0
(Riparian P Owner Information)
Signature

,/30/2012 21:29 000-000-0000 BOB & MEG ZACK PAGE 01
41g4e A14t tea/
CERTIFIED MAIL — RE U&N RECEIPT REQUESTED
DIVISION OF COASTAL ,MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to .1 ^ - fs
property located at 1 ,n �
�� (Name of Property Owner)
�,, (Lot, Block, oad, etc.)
on �`�WAMA
f C',,�Pr in _ , N.C.
bot3y) own and/or County)
Applicant's phone : 3 — ? 2 bailing Address: 8��
He/She has described to me as shown below tP
~r
ent he/she o osi t that location, _1
and I have no objections to the proposal. �- p 6 e�7
------------------------- - ----- ---- ��-- J.G��.---------------
DESCRIPTION G
AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing
If you have objections to what is being proposed, you must 11otify the Division of Coastal Management (DCM) in writing
witbin 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone].
o respqnse is cons•de ed the same as no o 'ection if ou hav een notified by Certified Mail
(Pro Owner Into io
Si �aature
Print or T e Name
S
(RipVift �perty r In ion)
or Type Name ,
Mailing Address
1J
1
0
Mailing Address A

)licant: Permit #�� Z�
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
►d in your Habitat code sheet.
itat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL Feet
(Applied for. (Anticipated final (Applied for. (Anticipated final
Disturbance total disturbance. Disturbance disturbance.
includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or temp restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
Dredge ❑ Fi Both El Other El0
Dredge ❑ Fill ❑ Both ❑ Other
/ zo
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 ❑