59280D - Pugh

CAMA / ❑ DREDGE & FILL
EN ERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized 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
Rules attached.
t N1' Project Location: County 2 li kl m t�
s I D, ampioi a a, Street Address/ State Road/ Lot #(s)
,Skfbca StateNC ZIP 2+21os b(JI(J��iG7L ti F��
Fax # ( ) Subdivision N /A
'ized AgentCaSAIJ(' 4 t '. City _ ' Ir Lt L111 kI/ (: NY A ( �. ZIP `1�
d ❑ CW A EW `PTA ❑ ES ElPTS Phone # ( w) � (3-33 River Basin LU rVA
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes no PNA yes / no
A Project/ Activity
0
ock)length
length
umber
ad/ Riprap length_
vg distance offshore
iax distance offshore
channel
ubic yards
imp - f
ruse/ Boatlif X 1 `-
Bulldozing
ne Length - JV l
not sure yes no
gs: not sure yes no
)rium: n/a yes no
no
. _
Attachedyes no
Ping permit may be required by:
Adj. Wtr. Body r1 DL (nat
Crit.Hab. yes / no~) Closest Maj. Wtr. Body A \ W W
r1f W )c t^u►��
L (Scale:
Ow i l 0 L U a A Isla 1"W(A C i- . ❑ See note on back regarding River Basin
17 Ah r, i, A -, I I ,. i, , , 1 F-7,, 1 c4 x L, n ,.,'ri 1­0,!. ,A i

ID
C�olc�sb�aw S�rec�

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
ly Eaves Perdue James H. Gregson Dee Freeman
-nor Director Secretary
AGENT AUTHORIZATION FORM
Date:
of Property Owner Applying for Permit: Name of Authorized Agent for this project:
i.ortviA4.1
is Mailing Address:
>I- 9 ear► P, `r'►a-CC_
u r +o ► N . C 2.72 or
ie Number (334 414b l700a
Agent's Mailing Address:
C0
Phone Numbe?(41
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
,nd obtaining all CAMA Permits necessary to install or construct the following (activity)
property located) at
s certification is valid thru (date)
P ope6"wnignature Date
RECEIVED

Doa.T +- ' ` % F . "
t,^
c�G
Fi

Nvw� ... �, •� rJ
� '� f O � O,S•E,,�'�1, `�
1Z- Gadsbora
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me of Property Owner:
(dress of Property:'
(Lot or Street #, Street
�plicant's phone ?j w
Mailing Address: ? r`t` i ! a
t 11)
ereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
s described to me as shown on the attached drawing the development they are proposing. A description of drawing,
th.dimensions, must be provided with this letter
D� I have no objections to this proposal. I have objections to this proposal.
you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
writingwithin 14 days of receipt of this notice. Correspondence should bemailed to 127 Cardinal Drive Ext.
ilmington, NC- 2 M5-3845. DCM representatives can also be 64itacted=at [phone]. No response is
nsidered the, same as no objection if you have been notified by Certifred-Maii.
WAIVER SECTION
nderstand: that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
propriate blank below.)
I do wish to waive the IS' set back requirement.
Vint or Type
I do not wish to waive the I S' set back requirement.
Print or Type Name
ailing Address Mailing Address
flrL-k - tl 3 r e`,n 1 i 11 A`I/, Ai r

I -�'- vcldi b 00".0
ddress of Propeity: i> ; f S u C CS cc�v� S f ti j 5 I,l a
,J ` j.,.
(Lot or. Street #, Street or Road, City & County)
PPlicant's phone#:!t-�'" .t Mailing Address: ; ft�� f
iereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
ks described to me as shown on -the attached drawing the development they are proposing. A description of drawing,
ith dimensions, must be provided with this letter.
lxc-_ I have no objections to this proposal. - I have objections to this proposal.
' you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
i writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
liimington, NC28405 3845. DCM representatives can also be contacted at [phone]. No response is
►nsidered the same as no objection if von have been notified- by Certified Mail.
WAIVER SECTION
mderstand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
i' front my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
)propriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
)erty.Owner Information)
� rT1
Tint or Type Name
10 7 -1 t�eee � e
[ailing Address
t 1\ c—
(Riparian Property Owner Information)
Signature
Print or Type Name
�i0:1 enrw V'It, G�-
Mailing Address-

plicant tsTfV Q
te: Qn
I-Zql) 2
Permit #: jC 2�O b
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 fin
disturbance.
Excludes any
restoration and
temp impact
amount)
W
Dredge ❑ Fill ❑ Both ❑ Other
I14
I
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 ❑