60721D - Hayes

CAMA / 'DREk3GE & FILL '/ NO. 60
3ENERAL PERMIT r Previous permit#
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources —fir ++ i
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / t� Z��
❑ Rules attached.
Name CA-91 (!ll Project Location: County Lk WSW I CY—
StateKj G ZIP 2_7�C 3
( )�CQ C1 —!jhI9Fax #( ) -
❑ CW ❑IEW L1f`PTA ❑ ES PTS
OEA ❑ HHF ❑ IH C UBA ❑ N/A
PWS: ❑ FC:
(es /, no PNA AO/ no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
CiZIP &40"
Phone # ( ) River Basin C�
Adj. Wtr. Body YY\C4j-60N1t q SL-COOL (n*G
Closest Maj. Wtr. Body Ar tvt l
Project/ Activity��
(Scale: 1 -
k) length
)i.Yx4`
igth
fiber
/ Riprap length
distance offshore-
( distance offshore
annel
is yards
P
;e/ Boatlift
illdozing
Length i CCU r
not sure yes
not sure yes avlr,
um: n/a yes �C®•f
yes fo
attached: yes no
ig permit may be require
d by: b &1L ❑ See note on back regarding River Basin

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Ref•) �
proer�-Y o�
Mr, J6 61h y W115on
Pier �or
Mr. Garef� Hayes
Pr.
toy

W b b f,Lr v �k .
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER MOORING PILINGSBOATLIFIlT/IBOATHOUSE)
I hereby certify that I own property adjacent to Gaw,TK Hoee- 5 's
(Name of Property Owner)
property located at _3 7 Do/p41ne, Dr. Oak Q Vc-
n (Lot, Block, Road, etc.)
on_ DLfV!5 CCi►)q ,in Oak ZSl4hd N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: [phone] Mailing Address: 51Z 3 56(h1 ter- K05e- Lon
RriiaoA , Nc 27703
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
?L I do wish to waive that setback requirement.
------------- -----------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Affacl ed
(Information for Property Owner Applying
for Permit)
(Riparian Property Owner Information)
'51Z3 .5tiw7 ,er Aose Lane -
Mailing Address Signature
RUr4-,w, Ne-- 277n-4

r,Jb btu v(-/
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
(3
I hereby certify that I own property adjacent to QM44 Hoye 5 is
(Name of Property Owner)
property located at 3 7 19 E - Pedp4 )ne Or. , Oaf-
n
(Lot, Block, Road, etc.)'
on_ L)aVlS CahQl/ in 00K TSlaoid N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:_9/7-Gi9-5719 Mailing Address: 51Z 3 Su mer KO$e. Z4n
RarAaai IVC 27703
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 (IS') 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)
Al*gc�ed
(Information for Property Owner Applying
for Permit)
SIZ3 Sccxime►- Rose LQKe-
Mailing Address
(Riparian Property Owner Information)
Signature
L?Ur w4, A/C- 277t)3

)plicant: �; AltMt H-A-Y�
ate: j 0! 4/ ( Z-
Permit #: (c 07 --)'
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
.bitat 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 fina
disturbance.
Excludes any
restoration and/c
temp impact
amount)
t A 1
© V V
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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 ❑