59198D - Price

ECAMA / `' DREDGE & FILL
/ 7179 159
GENERAL PERMIT
Previous permit# xv//.�
G'New ❑Modification Complete Reissue EPartial Reissue
Date previous permit issued f
iorized by the State of North Carolina, Department of Environment and Natural Resources
IS Ov
Coastal Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /
+ p
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p ules attached.
tnt Name 5/®� / l%�
Project Location: County �)P f!��.v
s 2/
Street Address/ State Road/ Lot #(s)
State NC--'ZiP Z7i 3Ca
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Subdivision
ized Agent Vw
City 5h ^��1�1'/ ZIP ? 7 S
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/River
Adj. Wtr. Body hGi%/l S/ /L� Fiat
❑ PWS: ❑ FC:
Closest Maj. Wtr. Bodyf'��'"
yes / no PNA yes ri Crit.Hab. yes l�n�
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent :o �na� ,�/ % �- s
(Name of Property Owner)
property located at
II (Address, Lot, Block, Road, etc.)
on �b�ar�- JuC��L� Care in�r�.S 1,%-) ,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
(Pro Owner Infor ion)
c
4;, 4��,
Signature
dvw a
Print or Type Name
Mailing Address
(Ripa7pe Owner Information)
Signatur
Print or Type Name —T
Mailing Address

Q��
NCDENR
North Carolina Department of Envire^ment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date 7 / 3 / -2
.applicant Name /Jort a. � � /a✓-I'CA
Mailing Address .2
I certify that l have authorized (agent) J-°Ii R 7 '` ""-
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)
This certification i valid t u fd te)
Signature �

(Idr1d`D.S ��►
tt �
zr �,�j2

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
i hereby certify that I own property adlacer.. /v ` ��
- -- s
property iocated at / 7J dAo4JI. L--%
on L adt,+ Ju c-�A
(Waterbody)
Agent's Name #:
Agent's phone #:
(Address, Lot, Block, road, etc.)
JAI- ( , in on s1vG.i
(Name of Property Owner)
City/Town and/or County)
titailing Address:
, N.C.
He/She has described to me as snown below the cove opment 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 Owner�Infor ation)
Signature
vww/ / k C�
Print or Type Name
(Riparian Property Owner Information)
i nature
not or Type Name nn
Mailing Add es
Mailing Address
n

r
'plicant: I Permit #:
ate: � � C
7 r
6
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
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
tempimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
1
W
Dredge ❑ Fill Both ❑ Other ❑
-3
3S
Dredge ❑ 'Filk Both ❑ Other ❑
2 �} 30
Z q3 0
Dredge Fill ❑ Both ❑ Other ❑
D CV
Dredge ❑ Fill ❑ Both ❑ OtFje��
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 0 Both ❑ Other ❑