59240D - Malone

VC.AMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
�`New _ Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
Drized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC —74-V �0 In
ules attached.
nt Name Project Location: County _ LI N SW ( CAL
t 1. Street Address/ State Road/ Lot #(s)
4q+4'1�- State` ZIP _ L " L� k N 4-s l..L l�l PI)
(1) G,.-IV ~-73 L" # ( ) Subdivision
zed Agent City K�K 1 S 1-AV 9 ZIP Z�IA
❑ Cw
❑^ V PTA
j
❑ OEA
❑ HHF ❑ IH
❑ PWS:
❑FC:
yes /1i0
PNA yes /(110-
at s _ PTS Phone # (cl l d) S99 -(O S3Z River Basin Y
❑ UBA ❑ N/A AiarvAdj. Wtr. Body GI I C
Crit.Hab. yes / no Closest Maj. Wtr. Body Ifi W W
n
of Project/ Activity Ky-xac�- G
ength
umber
ad/ Riprap length_
ig distance offshore
iax distance offshore
:hannel
jbic yards
imp
'use/ Boatlift
Bulldozing
fiiI x I ,
mmmmmA�mm��mm sum■
■■■■■■■■■ice:■�1■ ■ ■■■�
moot MEMO
❑ See note on back regarding River Basin

I UNIT
RIA
ADJACEYT RTPA-GP �G BOATLIFTBOATHO SE)
PERTY OWNER STATEN
(FOR A PIER/!1-IOORl V
I hereby certify that I own property adjacent to s - e 9f Property Owner)
property located at
iB ck,
l gadt , A� N.C.
on �. ('town and/or County)
(Waterbody)
the development he is proposing at that location, and, I have
He has described to m e, as shown below, pilings / boatlift /boathouse must be set
no objections to his proposal. I understand that spier/mooring from my om a of riparian access unless waived by me.
back a minimum distance of fifteen feet (1$i (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 frlled in by individual proposing develos� nt)
-
'4.-Pek- al- htr tnov,
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writ
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, N1
DCM representatives can also be contacted at [phone]_
No res once is considered the same as no ob'ection if von have been notified b Certified Mail
ti )
(Information for Property Owner/Applicant
Applying for permit)
Mailing Addressin—
City/StateJZip ff • %' �'✓
(Riparian Property Owner Inform- on
a
Signatur
tLI O AR L Ui �I.00
Print or Type Nan
,--7,"n - -7-10 C1/Z

Z, 4
pt
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N

'Wpivic%II. i*..=varRA VAP4,0IV4JUIQII rrwcl'
AD3AGE, T MARL4N PROPERTY OWNER STATEMENT
(.FD)t A PMR/D,[OORIIVG PZZVGSBOATLUTI'SOATHOUSFi
that I own pmprrry adjacent to ' r /'fe—/010
1 bmby c fY 'mne of Proptrty tea')
IS
.C.
W the dvolopFatliil ht i8 YO'P08� at tbAt 10ca 014 and. I have
He descrt'bed to me.sal umdt stud that a pi 9 / boadift / boathouse must be sat
no o *chose to his propo
&3m mm of fifteen feat (15� from My area of access unless vvainred by me.
back a minimum taint initial the spproprhte blank bdvw.)
(If you �wlsh to waive the •atback, you
I do not wish to waive
I do wish to waive that sdtbar3c MT —
nEg 7'ION AND/OR DRAWIxiG OF pROPOUD DEYRLMUNT:
(To be d In by Lndh4&91 Pro, "tA
l fie ao
�rk sre
e� dk)
ttyrov hay* obf.ctloa. to Rabat b beinS proposed, Y
OG mast aotlly tD.e Dtvts]oe or Co*rhi lNfsaµam.nt in wrltfz
Xtthtp 10 days of rwa pi of this wbtkL Ceer"PdtstA sboald be marled to 1. CardlDsl Driva Val. WUndogtos, NC
DM r+promtsttwa can sbo be contB4W al MO) 796-77,15,
0
anfornutiorf forknpaV OivMVApP=uL p opertp Owner Info
A,Vplyiat for permIQ
J
MaiAA&M
ty' tatlTap
Rr�rtRo ��rr�4r�, —
"" Print or Zypa Namo
Tolevbone Number

C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: - C� Permit #-. Z 7
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
ind 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 fir
disturbance.
Excludes any
restoration anc
temp impact
amount)
(�Vi
�
Dredge ❑ Fill ❑ Both ❑ Other L /Z
2­+"y
Dredge ❑ Fill ❑ Both ❑ Other 6/
z `'(
ZZ (-
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 ❑