59256D - Scott

CAMA / ❑ DREDGE & FILL
ENERAL PERMIT Previous permit#
New Modification LIComplete Reissue El Partial Reissue Date previous permit issued
orized 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
j Rules attached.
nt Name Project Location: County T'" nsw i C' L
s 125 `►- S ylV e,
4 Street Address/ State Road/ Lot #(s)
�1a 11 b4t Statec ZIP � D �u 1� I (1 , \ l u Q
# ( 1 !G )�— tP3 Fax # ( ) Subdivision 5`'{ ' V 0 r
•ized Agent City ZIP
d CW ❑ EW }PTA
C OEA ❑ HHF ❑ IH
I:
❑ PWs: ❑ FC:
yes / no PNA yes / no
of Project/ Activity
lock) length is
rm(s) 0X 1 lox 1
pier(s)
length
lumber
ead/ Riprap length
ivg distance offshore
nax distance offshore
i
channel
:ubic yards
amp
Ouse/ Boatlift x 4 I
Bulldozing
❑ ES ❑ PTS Phone # River
Basin
❑ usA ❑ N/A Adj. Wtr. Body
Crit.Hab. yes / no Closest Maj. Wtr. Body �� w I/\ )
0
■■■■■MA■■■■L■■■■W AIME■
- � ■■■■■ice■■■■�■■■�i■■■
DPP c" c ■
(Scale: I //
❑ See note on back regarding River Basin
- - i (._I . - f - I - 1'

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
{FOIL A PIER MOORING P'ILI)VGSIBOAI'LIFTIBOATHOUSE)
I hereby certify that I own property adjacent to I�Q�P�I �t"4j&VAIS
(Name of Property Owner)
property Located at
G.O D 16
(Lot, Block, Aoad, etc.)
on �( e.r in �5�ru IUS ICJ IC- UA
(Waterbody) (Town an or County)f
Applicant's phone #: � W wiling Address: j mo AI( D/A,
0 ?6
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 pierlmooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I Y) from my area of riparian access unless
waived by me. (If you wish to avaive the setback, you must initial the appropriate blank
beloti.)
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 individual proposing developmenf)
�r Ra-4'l�RG1P¢ EXAi Gi� �7 11
(Information for Property Owner Applying
for Permit) or
V o"ii-
Mailing Address
ji�q4 // /'/ Ae A Witvtatr /tin
(Riparian Property Owner Information)
Signature
h-
Print or Type Name

VIAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to& t/___ ] i "4kc5-1U-U `s
(Name of Property Owner)
property located at
4S
(Lot, Block, Road, etc.) '
on r b _ , in Zralisk).'ek , N.C.
(Waterbody) (Town and/or County)
1�
Applicant's phone /!: Mailing Address:
He has described to me, as shown below, the development be 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 (I Y) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you roust initial the appropriate blank
below.)
I do not wish to waive
I do wish to- waive that setback requirement.
DESCRIPTION AND/OR DRAWING OR PROPOSED DEVP,LOPMENT: - ' -
(To be filled in by individual proposing developmend)
�Q Q-
(Information for Property Owner Applying
for Permit)
Mailing Address
�� A1c 4 Wd
(Riparian Property Owner Information)
Signature
Prins or Tvne. Name

- V v •v
4 u� folA
T
w
Im

ca
nt: O 22�� t�lvl�G� Ste- Permit #:
5�3`�2
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ri in vniir Habitat code sheet.
TOTAL Sq. Ft.
F
(Applied for.
(p
DISTURB TYPE
Disturbance total
tat Name
Choose
One
includes any
anticipated
restoration or
temp impacts)
it
Dredge ❑
Fill ❑
Both ❑
Other
l (�
Dredge ❑
Fill ❑
Both ❑
Other
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 0
Both ❑
Other 0
NAL Sq. Ft.
TOTAL Feet
FINAL Feet
nticipated final
(Applied for.
(Anticipated final
disturbance.
Disturbance
disturbance.
xcludes any
total includes
any anticipated
Excludes any
restoration and/or
restoration
and/or temp
restoration or
temp impact