59156D - Marshall

ICAMA / C DREDGE &FILL i j iD9
3'ENERAL PERMIT Previous permit#
�Vevv ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_ 10V
ized by the State of North Carolina, Department of Environment and Natural Resources -/ 7
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �Z OU
❑ Wes attached.
t Name � �"I '� f � S 1TIrLC .- Project Location: County &-41
0t Ty
�ST State f`-�" ZIP ? 3
(20h %j11- 12-7 Fax # ( )
ad Agent N 1A:
❑ CW ,SEW �TA ❑ ES ❑ PTS
ElOEA ElHHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Street Address/ State Road/ Lot #(s)
Subdivision per: •%
City H ��YI/ ''T�' ZI PJ
Phone # )1'+317 - S/ Z7 River Basin
Adj. Wtr. Body ( �.{LC X2._. nat /n
yes no PNA `i.`.J/ no Crit.Hab. yes / j Closest Maj. Wtr. Body T AL.
Project/ Activity VV
(Scale:
:k) length
igth
nber
I/ Riprap length
distance offshore
c distance offshore
annel
is yards
P
oatlift
Ildozing
Length t
not sure yes ``no
I.
not sure yes
im: n/a yes s no
yes r no
ttached: �~ no
g permit may be required by:
- L� El See note on back regarding River Basin
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500 ft P IkO,
200 "M

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to ?e,7-6W 4 &TJt1f SH--lWs
(Name of Property Owner)
property located at 104- —fzz:> Lot-,jr *F5 (81(Z 1AAUA40 ?)Aq
(Lot, Block, Road, etc.)
on 14 o1-°ls cRh-, , in �4t� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: _ U1- 317—J(L7 Mailing Address:
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
"X I do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
kmkeffe-p
(Information for Property Owner Applying
for Permit)
(Riparian Property Owner Information)
104
Mailing Address
Signature

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Tfrf . 4 Clwt MAr"*ALL 's
(Name of Property Owner)
property located at 10 If -DXA VLF._- -4p L, ,, 5 -Pb 1 3/ t JAAW W ,gAY
(Lot, Block, Road, etc.)
on N IXo 0 QXf-LK- , in TAP , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Z°J' 3t 7 - Yi z7 Mailing Address:
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
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
AT —6keff4P
(Information for Property Owner Applying
for Permit)
(Riparian Property Owner Information)
I ° `f R-A, k-p— 2
Mailing Address
Signature

m
v

ALT4
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3everly Eaves Perdue
,overnor
Dee Freei
Secre
AGENT AUTHORIZATION FORM
Date: 2 Z8 Z
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
P,tru_ 4 e*TVIg Akr*H ok L-L .:J'A6, J )A iL
wner's Mailing Address:
Agent's Mailing Address:
Zg C.4,cyj.Jq,_ aR E Kr
hone Number (?q) 3(7 - 1i Z7 Phone Number (910 ) 794, - 7Z 7-1
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
ny property located) at 4 _PAA A�E- -99-> e2mab �Jc- 74 ` 43
his certification is valid thru (date)
2

licant:
0z'
kip
Permit #:
;vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet. .
tat 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)
i c
j
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 ❑
Dredge 0 Fill ❑ Both ❑ Other ❑