60606D - Mathis

-'LAMA / r DREDGE & FILL No. 60,
.ENERAL PERMIT Previous permit # ti
New ' —]Modification !Complete Reissue EPartial Reissue Date previous permit issued_
rized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
�y❑,Rules a ched.
it Name Q iNE N N � l "S� ' y 4T11I S Project Location: County1�, V` S �G J
U 1 Street Address/ State Road/ Lot #(s)
I &1TD �.1 State� _bZIP 1( S2 A IJA� U, 7PIL .
`ft) Z" ' 1�nlax # ( ' - Subdivision _ p
:ed Agent ri -17AA A City 4�2 Nrl-ftS '�s-�-r �1 ZIP 2-� 14
❑ Cw W TA ❑ PTS Phone # ( ..}^--• River Basin LtJ kl
❑ OEA ❑ HHF IH = UBA ❑ N/A
Adj. Wtr. Body ,,"A nJA t- 4FF A' f (Al w
❑ PWS: ❑ FC: yes no , PNA yes / o Crit.Hab. yes 'f( o Closest Maj. Wtr. Body / + GT
L)
f Project/ Activity I r17S 1 ! t J � `� ! I'� '� 1 N OIJ tp VV ^ to to
bf- Did 6..S�/,Jee- (Z:S Wlk & " (l
(Scale: � ._.
ck) length_
ngthdJ V S t O[
tuber
Riprap length
g distance offshore 1
uc distance offshore
iannel
bic yards fit- T—
np 1#�+s � wa l
ise/ Boatlift
ulldozing
e Length y J` ��9 �/jj ATA
not sure yes no p ✓ G'V H a /,t�0 _
s: not sure yes, n
ium: n/a yes o
yes _ --
kttached: yes no
ng permit may be required by: U V51 QnA/ C•� ElSee note on back regarding River Basin r
c---...l / -%A 'Cl G L' .. I ! / i '. �. _ .. 1 / /1-1 'd it ri l l

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I nereby certify that I own property adjacen::o --C�, _ t � 's
property located at 0
(Name of Property Owner)
4j , ,C,
(Address, Lot, Block, oad, etc.)
n
on HLk1�ej�- �,y,��� PGnu1 in 5r` S e_t`r N.C.
(Waterbody)
Agent's Name #:
Agent's phone #:
�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.nccoastalmangementnet/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
(Progerty Owner Information)
Signature / \,
/ ,h r,5
rime Name
Mailing Address
Property-�Qwger Inform
r h. �= ih 6" e.
not or Type NA}ie
3r-\<'
UDo 4u�
Mailin A Tess )

DIVISION OF COASTAi_ MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
i nereby certify that I own property adjacent to Cxflf A I�IA7 11 f
I
( a e of Property Owner)
Cct Yid
property located at ' / r'�� ��ry /V C
(Address, Lot, Block, Road, etc.)
on j4y Gklf-� .. r US4'Ce, (Q ✓►d in , �Ordr f-f1W N.C.
(Waterbody)
Agent's Name #:
Agent's phone #:
(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
(Property Owner Information)
Signature
Print or Type Name
t106l klbel� 4-rAx_
Mailif �g Address
,^7, % - . . . _ -,, -7-7 y
,Riparian Property Owner Information)
Z? _shy ,
Signature
Print or Type Name
f l 9 rala /,►�
Mailing Address

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name qf Property Owner Applying for Permit:
Mailing Address:
10 Lbe, LoL,(\-P-
-r"LL, , k),.(. Qnav
l
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) � - � O " % ;-
MON
Property Owner Signature
Date

)plicant:. C4
ate: 7 - -
'D Permit
scribe 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/o
temp impact
amount)
Dredge ❑ Fill Both ❑ Other ❑
70 f,
010,
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 ❑