60747D - Munn

CAMA / DREDGE & FILL / NO. 60J
3,ENERAL PERMIT I/ Previous permit#
New ❑ Modification ❑ Complete Reissue ❑i Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1240'
R I hed
Name t/l &4-1117
,�3D r /� t I�piti fi jar.
by X*Vev A-7 State IWZIP20410
(VA Fax # ( )_
ed Agent �
CW e4W 'UPTA 'ES PTS
❑ OEA ❑ HHF IH ❑ UBA = I N/A
❑ PWS: ❑ FC:
7 sew rrAMiii.
:k) length
er(s)
igth
nber
I/ Riprap length_
distance offshore
( distance offshore
❑ uesa c
Project Location: County
Street Address/ State Road/ Lot #(s)
Se) Z-h It l 0��4 1O%eViA-
�✓ .
Subdivision Ta �,/e A/�►r
City I// &P, ZIP? %
Phone # O River Basin
Adj. Wtr. Body 4YA4-1z/' (nat d
_/i. 1I /0-
Length r
not sure yes o
not sure yes (n
um: n/a yeseo
yes - -
,ttached:no
ig permit may be required by:
❑ See note on back regarding River Basin rL

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i ' i 's
(Nime of Property owner)
property located at
(Address, Lot, Block, Road, etc.)
onµ �. r' 1 ., z in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
2144 I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
RECEIVED
DCM MMINGTON, NC
0CT.2 2 2012
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 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 wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement,
!Property Owner information)
�L� /o—.—
Sl nature
Print or Type Name
(Adjacent Property Ownef Information)
Sign Tf
t l&L,
Print or TyAe8 ,1 f

Au/ vc�,-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to EAU % f6 00 N r 's
(Nameof Property Owner)
property located at ,3 TA) L 7—P01 01:z ,
(Lot, Block, Road, etc.)
on L Iq N , in W t L N Toto , N.C.
(Waterbody) (Town a d r County)
Applicant's phone #: 91 C - (o 11-1y �cj Mailing Address: 13P LN L CT Nor QR, ve
Lud'Ki�tT c PSQ 1
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. �0� a a� � r v- . c9hte— ' "a
--------------------------------------------------------------- -- ------------------ ------ %.V-4
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(15Z=c:--AlTKh°E-6�
(Information for Property Owner Applying
for Permit)
� 3 Li OCkAC a K%:� Ott.
Mailing Address
----------------------------------------------------------
(Riparian Property Owner Information)
l
ignature

Boat Lift
11x14.5
)sed Existing
n 10x15 Platform 10x10 F
Floatine Dock 6x50
l ov ` --- "�

C Division of Coastal Mgt. Habitat Impact Computer Sheet
olicant: I�' Permit #: 6o
te:
llj�z2 �/Z
scribe 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount
/ ^ /
OW
Dredge ❑ Fill ❑ Both ❑ Other
.310
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 ❑