59187D - Royster

ICAMA / ❑ DREDGE & FILL � ` 9
GENERAL PERMIT Previous permit # A
]New" ❑Modification [-]Complete Reissue El Partial Reissue Date previous permit issued it
Ozed by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
v ❑Rules ched.
it Name SU-5'ktA f �� �k.,...,,, Project Location: County
Street Address/ State Road/ Lot #(s)
"1 state
�L�zlP G% S
() 7s7Fax # () Subdivision
r-
tedAgent �f LGL l ,ti i �-� City ''� ZIP
❑ CW W %ETA ❑ ES ❑ PTS Phone # ( ) River Basin
ElOEA / ❑`HHF ❑ IH USA ❑ N/A
❑ PWS: El FC: Adj. Wtr. Body s^C r� a
PNA yes (fio_) Crit.Hab. yes
f Project/ Activity
Kk) length
:ngth
amber
A/ Riprap length
g distance offshore
ax distance offshore
hannel
bic yards
Tip
ise/ Boatlift
plWozing
I�
e Length -i"' —
not sureJyes: not sureium: n/aAttached:
ng permit may be required by: 461
Closest Maj. Wtr. Body
!�
(Scale: 1 ",=
C ❑ See note on back /lregarding River Basin r

(FORA PIERIMOORING PILINGSBOATLIFTBOATSOUSE)
I hereby certify that I own property adjacent to S U 5 4 f J V C `/ - t 1Q `s
(Name of Property Owner)
property located at TbrP6A,'� Br ►� C L
� � � µ U ►�1 � � � F y �-� � ,
(Lot, Block, Road, etc.) nn __
on i Q`� i S O U ri ' , in 2 O ' l__o uV1 N.C.
1 (Waterbody) (Town and/or County)
Applicant's phone A 1 q— 6otailing Address: C 310 � R O p kG�N 1) �
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 thata 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
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fidled in by individual proposing development)
(Information for Property Owner Applying r (Riparian Property Owner Information) Y
for Permit)
131 D IRb D
Mailing Address Signature
C-
City/Statedie Print or Type Name

WEDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
everly Eaves Perdue Braxton C. Davis
ovemor Director
AGENT AUTHORIZATION FORM
Date:
me of Property Owner Applying for Permit:
vJ oi�iC�
ner's Mailing Address:
JD ISRUO CGREE� DA
GAC� 17.511
me Number 7
Dee Fre(
Secr
Name of Authorized Agent for this project:
R; LL E i)WARU
Agent's Mailing Address:
1112 8 R0QVSq LZ J M .
CA&J t�c 175JI
Phone Number(711) �(FD 3 / q O
rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
DA Ar FLoATMG DOCK Ti) EALS C;6G D0Ck
my property located at I lc� i-� u 114 P H R � y Ac�r✓ , 1 D PS AjL b � h � F�
certification is valid thru (date)
r _
t h�
Property Owner Sligmagre
Date
F

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)plicarlt: •?/'�p�/>� 1 ��{� Permit #:
ite:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and 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 final
disturbance.
Excludes any
restoration and/o
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
D
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 ❑