60726D - Porter

-7CAMA / - DREDGE & FILL / NO. 6O
3ENERAL PERMIT V Previous permit#
?Blew -Modification '-Complete Reissue -Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 1 /f
_oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
t Name_ �i%fixxi� Project Location: County
'dkiL ��
/3�hlf Street Address/ State Road/ Lot #(s)
AFO I01A l AO,( h State Me- ZIP �?
(*) 24712 3 Fax # ( ) ----
ed Agent 'N4r4 f-rh i, '
-e
CW EW _'4TA ES L] PTS
OEA HHF - IH UBA ❑ N/A
_ PWS: ❑FC:
yes le. ` PNA yes / Crit.Hab. yes /)
Subdivision
City_ ZIP
Phone # O River Basin
Adj. Wtr. Body nat
Closest Maj. Wtr. Body Ofl� G
A Project/ Activity fZ-1ll, /4 NrA &W7 1:11 � to#-/S //1,4
(Scale: =
ock) length
ength
umber
ad/ Riprap length
✓g distance offshore
_
iax distance offshore
17
:hannel
ibic yards
em l�
imp
-
J
ie Length i �t . 7r
not sure yes
gs: not sure yes/
rium:a % yes no
Vi
- no p N
Attached: CY�3sno �! l r
( i— /
ing permit may be required by:. aa, �.4 .
❑ See note on back regarding River Basin :

a��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
verly Eaves Perdue Braxton C. Davis
ivernor Director
AGENT AUTHORIZATION FORM
Date:
ie of Property Owner Applying for Permit
)&\M V. "'Per K
ne Numbera$ labs-' -+,Tbq
Dee Freeme
Secretai
Name of Authorizes Agent for his project:
�e r►rell
Agent's Mailing Address:
u &x Z532
Phone Number � �23 2- Y3
lift' that I have authorized the agent listed above to act on my behalf, for the purpose of applying
ind obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at
certification is valid thru (date)
P
Property Owner Signature Date
RECEIVED
DCM WILMINGTON, l'
S E P 1 7 2012

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ (J2� , 0 'Pp f let- 's
4N
0 we of Property Owner)
property located at (3 n ( J I
(Address, , Block lRoad, etc.)
on rA c 1/,�j`',1 C) in 4 I t a Ct J 2 PQC N.C.
—� (Waterbody) (City/Town and/or County)
The applic t has described to me, as shown below, the development proposed at the above location.
1 have no objection to this proposal. -e�
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 WILMINGTON, N(
S E P 17 200
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.)
wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Pro erty Owner Information) (AdjacentProperty Owner Information)
A'
Signature ti�oatr
�-
Print or Type��vvame Print or Type Name

f�e o
) qlt"
1 C ' -4
ix
,24
c-' 1 �'- / -4
0 e,
A
0 1�
pro po 5co
RECEIVED
DCM WILMINGTON, N
SEP 17 202

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -Da-, i P PCB 1 c-t s
Name of Property Owner)
property located at _� � � �'��, ��� , �� ,
P 5iC (Address,
on in_
(Waterbody)
� 7th �etc•�e�iC�
(City/Town and/or County)
, N.C.
j
e a plicant has described to me, as shown below, the development proposed at the above location.
K
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 WILMINGTON, NC
SEP172012
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
ninimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
he setback, you must initial the appropriate blank below.)
K� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
pro rty Owner Information) (Adjace t Prope00wr Informatio
U ) 4�6� e�_
D L°� - 6�-� :�4_
ignature Signature
�a�i
int or Type Name Prat qr Type Name/ �h

IC Division of Coastal Mgt. Habitat Impact Cc mPuter Sheet
Q ?2
Permit #: �
,pplicant: � V/"
late: '1'��-I rL
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
t
DISTURB TYPE
iabitat Name Choose One
V
Dredge El
Fill ❑
Both [I Other
Dredge ❑
Fill ❑
Both ❑
Other El
Dredge ❑
Fill ❑
Both El
Other El
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both El
Other ❑
Dredge ❑
Fill El
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other El
Dredge ❑
Fill ❑
Both El
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other [IDredge
❑
Fill ❑
Both El
Other El
Dredge ❑
Fill ❑
Both ❑
Other [IDredge
❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill El
Both [I
Other ❑
Dredge ❑
Fill ❑ Both ❑
Other ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
for.
FINAL Fee
(Anticipated final
(Applied for.
Disturbance total
(Anticipated final
disturbance.
(Applied
Disturbance
disturbance.
includes any
Excludes any
total includes
any anticipated
Excludes any
restoration and/or
anticipated
restoration or
restoration
and/ortemp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)