59287D - Knox

CAMA / ❑DREDGE &FILL59
3"ENERAL PERMIT Previous permit#
KNew ❑Modification []Complete Reissue El Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources l j
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC n • L�
Rules attached
it Name ( !(A X
(Vi State ZIP ?N4 1Z
E (Q) Fax # ( )
:ed Agent
❑ CW I �] EW APTA
❑ OEA ❑` HHF ❑ IH
❑ PWS:
yes no PNA yes
❑ FC:
f Project/ Activity
If
Pck) length X
-1(s)
Xiier(s)
;ngth
tuber
d/ Riprap length
g distance offshore
ix distance offshore
hannel
bic yards
np
ise/ Boatlift
ulldozing _ _-
w tiv Ito
e Length L t 2-1
not sure yes no
t�_
f I ES ❑ PTS
G UBA ❑ N/A
Crit.Hab. yes ( no
Project Location: Count'vu i L-h-
Street Address/ State Road/ Lot #(s)
Subdivision
City . vise ZIP 11 -
Phone # ( ) River Basin W W
Adj. Wtr. Body i.UCl vat'd @ )" '►Yf�r
Closest Maj. Wtr. Body N)
(Scale:
❑ See note on back regarding River Basin r

��-b a44 v
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORING PHUNGSBOATLIFTBOATAOUSE)
I hereby certify that I own property adjacent to k hrox 's
(Name of roperty Owner)
property located at J� Imo`' i u e r U i FDA Dr
(Lot, Block, Road, etc.)
on &6�p Cioa-�irin S4-,se+ "/ �f� N Sw�c� Cja , N.C.
(Waterbody) ('Town and/or County)
Applicant's phone Mailing Address: G, ox /O}f
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 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
TFI do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
3�ec Ova. 17
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
d - 136x I O L(
Mailing Address ignature
Y
City/State/Zip Print or Type Name

*Wb aA4.4 V*A-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 1'W,4f II(N O is
(NAme of Property Owner)
property located at �" 4 & v,r ,,I e I
(Lot, Block, Road, etc.) j
on = l 5 T�r-� 1) � C�Q (.L',/k Sca,J are r f u r aJ� e � C9 N.C.
(Waterbody) (Town an or County)
Applicant's phone �(1 41 Z 156 3 Mailing Address: P O. f O-A 164-
&ll i u; « OC u- L,
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 (I T) 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
r� _' ' fo wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
pier f F I Q2`i1�` Dec.L
S o p P(A—� Ao-�4,
(Information for Property Owner Applying
for Permit)
P0, (3on (O
Mailing Address
U1 v,ok N.C. a8g22�
City/State/Zip
(Riparian Property Owner Information)
t
isnature
H 's
Print or Type Name

o svlr
46to am-
M i
I�e

-DN -#Ijijlv ils"
ikia'71'� tr4
§ I�_
,

E. DWIGHT KNOX
MRS. E. D. KNOX
P.O. BOX 104 PH. 253-6349
550 GREEN LEWIS RD.
BOLIVIA, NC 28422
r Date
13983
66-112/531
Pay to the
Order of t4f D �N )q,
7449
Dollars
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BEIT BEIT com
For—ap Np

Applicant:
Date:
I Z (�-
Permit #: 9� 2-'�-4
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuren
found in your Habitat code sheet.
Habitat 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 Fee
(Anticipated
disturbance.
Excludes an
restoration e
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ OthEe
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 0 Both ❑ Other ❑