60618D - Spivey

�CAMA / ' DREDGE & FILL ✓ No. 6Q
ENERAL PERMIT Previous permit #
E)New Modification ❑Complete Reissue _ Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources , /2G�
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /`�
ules�attac�
attached.
ant Name J e Project Location: County /�Gtti 17'rt*e
s L$/ P 14. Street Address/ State Road/ Lot #(s)
"y rhir %j%ri State A/C zip ZON11 rM
# CT/A :? � -6123 Fax # ( ) Subdivision
ized Agent OAwjt lRt! O t City ZIP
d Cw P€'W :ETA = ES -- PTS Phone # ( _) River Basin
❑ OEA I J HHF - IH UBA —1 N/A Adj. Wtr. Body .41W4- (nat
❑ PWS: 7 FC:
nes / no PNA yes' / Crit.Hab. yes /
Closest Maj. Wtr. Body__ Z �lM� �
A Project/ Activity
ock) length '
�s ',rio r�nr'tc�
pier(s)
length
umber --
ad/ Riprap length
vg distance offshore
iax distance offshore
channel --
ubic yards
imp
)use/ Boatlift
Bulldozing
`' /e.� fit✓
is N- A0
ne Length
not sure yes
gs: not sure yes r9l
)rium: /a' yes no
no
Attached: yes 61;'
(Scale: /At
= .
ling permit may be required by: �Y&s, H44yerli/ LI See note on back regarding River Basin

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER✓MOORING PILINGS/BOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to Ca ( rA'4. L , 1�b 1 p , / is
(Name of Property Owher)
property located at
(Lot, Bloc"oad, etc.
f
on !► , injp�E�V+nin Dom.)/ind�o N.C.
(Waterbody) low and/or County) ��
Applicant's phone #:nl V-IRIZ Mailing Address: Pq—,o ,19py.a,(Q1.�
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 that a 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 A-ND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in
RECEIVED
JUN 2 7 2012
DCM WILMINGTON, NC
(Information for Property Owner Applying
for Permit)
_P-0, s:a(gQ4-
MiMailing Address tt
City/State/Zip
(Riparian Property Owner Information)
ature
Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATIIOUSE)
I hereby certify that I own property adjacent to CA (( j e , L. �;�p y jo i is
(Name of Property Owne
property located at
(Lot, Block, RoAd, etc.)
on��1iL)i,-(Cyo2z1 �, �( In (�7 16'1t,63 Dh t�0«i �cLr M((�Y, N.C.
(Waterbody) ! ( n a d/or County)
Applicant's phone #:0 1r)U a Mailing Address: m aN„� �01
1 4tl A -.A— . iP �r
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 that a 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.)
_ y I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individical prop osin& development)
JUN 27
DCM WILMINGTON,
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
� S
Mailing Address
ity/State/Zip
C
0 Signature
Print or Type Name

�licant: (f 4r Al'e s� l ✓� y
';44f12
Permit #: 0�if� 11
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
tat 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/or
temp impact
amount)
vv
Dredge ElFill ❑ Both ElOther
/
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 ❑