60611D - Mitchell

APAMA % - DREDGE & FILL N2 O'
GENERAL PERMIT Previous permit#
ew Modification 'Complete Reissue _-Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources x ,l
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 714 V (J
it Name f CIA '" VIP" OF vl I I ALA
,
t W / A - a State/' ZIP
/ ` _ 1t )
zed Agent /f +�,47W e�;%`i/!-f C
i CW .-IJIW AFTA ES J PTS
❑ OEA I ] HHF ❑ IH UBA i7 N/A
❑ PWS: ❑ FC:
LyeoV no PNA yes /.,4C67� Crit.Hab. yes
f Project/ Activity Lair < /q
Dck) lengtth,_ _ ______
pier(s) ,o
ength
ember
ad/ Riprap length
ig distance offshore
iax distance offshore
Project Location: County
Street Address/ State Road/ Lot #(s)
r ,f ( N/ �.
Subdivision
City �� ZIPZ
Phone # ( ) I fiver Basin C_
Adj. Wtr. Body i'✓
Closest Maj. Wtr. Body 0 v
V1
I I ,
ems, ram, r
:hannel
is
jbic yards_ •
mp
use/ Boatlift �
t.
3ulldo ing j �' �T "� �3 ' ;r / ,•�' / ���'+ / Ld
(Scale:
.t—
ne Length
not sure yes o
- -
gs: not sure yes
rium: n/a yes
yes 610
Attached: yes
ling permit may be required by: , e� See note on back regarding River Basin

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to �], c��/j-�� �. , /7,�C// 's
(Name of Property Owner)
property located at Ukl 141r, -111
(Address, Lot, Block, Road,, etc.)
on(; T'c,/ in�tT��lz'�� N.C.
(Waterbody)
Agent's Name #: `L!�/ � -PY
Agent's phone #: %f/-4
(City/Town and/or County)
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION 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 notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
(Pro 2E2z!;
n)
' l'b L AA--1
Signature
4,-1 41. /Y1 1c4e`l
Print or Type Name
<7 (lq
4gnatui(R'ian Property Owner Infor ation)
e
Print or Type Name
/X 17 Z"
Mailina Address
Mailina Address

/09/2012 MON 18:01 FAX [phone] WHITE TRACTOR CO
F��' �' � �" y��( ��' �^mil �
DIVISION OF COASTAL MANAGEMENT
�AD.IAC
CERTIFIED ENT IMAIL RRETURN RECEIPT REQUESTED
FORM
l/s
I hereby certify that 1 own property adjacent to�i'i
t (Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on r-- l-lilt ,inTTr I N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: ��y -�/� Mailing Address. -
Agent's phone #:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the propasai.
------- _------------- ------------- --------------- ---------------------
DESCRIPTION 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 notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
ava►labla st www.neeoastalmangementnet/contact dcm.htm or by tailing 1-888-4RCOAST. No
response is considered the same as no objection if you have been nor/fled by Certified Mail.
(Props O mar)nformation)
Cam,
Signature
,melt
Tint or Type Narne
Ow-1 ll&ki<,
Wailing Address
City/State/Zip
(Ri
Information)
r Si
gnaature
Print or Type Name
1. 0A(-,V �
Me- Address
XCity a ip

MI
J2+r90 I-1
01
000
Z
40-1 u0 �)1yfud �2 , 3 �

Dplicant: / 6V'Ld
t�
ate:
7
Permit #: � 06
_ /'
sscribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
DISTURB TYPE
bitat Name 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 ❑
�y
-.AOJ-..
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 ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) A6 to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity)
at (my property located at) C 1� ✓ G� S z 4,J rly
This certification is valid thru (date) �— /) 0—
,eAlgkik 71Y
Property Owner Signature Date