60725D - Lewis

CAMA / -' DREDGE & FILL
/ NO. 601
"EN ERAL PERMIT
{/ Previous permit #
New -Modification Complete Reissue
-.Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources / 11
�21"
oastal Resources Commission in an area of environmental
concern pursuant to I SA NCAC �/ /
Rules attached.
Name-T",o
g4o/ 4"i v t&,y
T
� Project Location: County We4i--
Lit �,� ,
Street Address/ State Road/ Lot #(s)
State ZIP
tw
Fax # () �—
Subdivision
;dAgent Ejtl VGh C'enrt✓-
City mil//JrHr�,�pii ZIP 't
VCW FIEW JRY' , ❑ ES ❑ PTS
Phone # ( ) /S'" y�� % River Basin
❑ OEA HHF IH — UBA - N/A
Adj. Wtr. Body /`Yf'Y (na
❑ PWS: ❑ FC:
N'
no PNA ' no Crit.Hab.
�� V
yes / no Closest Maj. Wtr. Body
Project/ Activity C D��'7`�"<'d" d,/ A ,fJ//re�7/ �e„r�i•,.5 lit�11
k) length (bsXfY "
S) /o km
;r(s)
gth
fiber
Riprap length_
distance offshore-
: distance offshore
tnnel
c yards
P
e/ Boatlift
C. 17 %V40re- -2
�-
Ildfyzirig
t i
Length Sa {
not sure yes 1 j
not sure yes 0
i
im: 6. yes no
yes
:tacked: yes
g permit may be required by: / Te
pecial Conditions
N C!J . T
(Scale: �
W�
❑ See note on back regarding River Basin

4
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
overly Eaves Perdue Braxton C. Davis Dee Freem
)vernor Director Secret,
AGENT AUTHORIZATION FORM
Date: *1�
ne of Property Owner Ap ly'ng for Permit: Name of Authorized Agent for this project:
,� L-e� ►�S i`E�'ils ��c��► Cz
ner's Mailing Address: n p Agent's Mailing Address:
g60-7 ili,e
c IF 9 c 3�►�dfl
me Number (ql q) Ibq b -5-C bz
Phone Number A O) q D-.s
,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):
h xt6k a- 'FI c A\ Ac k
r my property located at L46 0-1 ZC k M
certification is valid thru (date) 3® ��
Propertwner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Ye V t, P- / k , nnewki 's
(Name o Prope Owner)
property located at L460 % 4 k (
(Lot, Block, Road, etc.) 9
on -rc, -' 1b�01, ort �VJRdn .New , N.C.
(Waterbbody) (TYvn and/or County)
Applicant's phone #: 1T `� 0 Mailing Address: ( 01
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
for Permit)
f '�rcr�q 5- -
Mailing Address
RECEIVED
DCM WILMINGTON, NC
SEP 1 3 2M
(Riparian Property O mer In
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent j to's
( &am of Pro erty Owner)
property located at 9 W 7 C� q b0 kle W `SuC �L ,
(Lot, Bloc , Road, etc.)
on M ` MCt4©qIM �Ok , in i i UQ C &WUC , N.C.
(Waterbody) (T and/or County)
Applicant's phone # 10 1 r1]> t Mailing Address:
►� 1 N ,�OC 760y0
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
for Permit) `r
J 01
Mailing Address
RECEIVED
DCM WILMINGTON, NC
SEP 13 20J2
(Riparian Property Owner Information)
Signature
< f N LE
t M

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
pplicant: ��y Permit #:
gate:
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
>und in your Habitat code sheet.
abitat 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
yXf%
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 ❑ Fill ❑ Both ❑ Other ❑