59147D - Schmidt

CAMA / DREDGE & FILL
GENERAL PERMIT
Previous permit #
New Modification Complete Reissue Partial Reissue
Date previous permit issued
Iued by the State of North Carolina, Department of Environment and
Natural Resources
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Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
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Project Location:
Rule* attached.
County �i/ RSWI
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StreetAddress/ State Road/ Lot (s)
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(_ _ ) 4 ( I Pq I Fax # ( )
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ized Agent i�i m'
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City
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btt �' a-L ZIP 41
CW EW a PTA iS - PTS
Phone # 0)
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1 6 River Basin tom/ m
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C OEA HHF ❑ IH — UBA — N/A
Adj. Wtr. Body
-- �r,
N ll.� (nat
i PWS: ❑FC:
yes / no PNA yes no Crl yes no
Closest Maj. Wtr. Body v.
of Project/ Activity 1
lock) length
rm(s)_
pier(s)
length
lumber
ead/ prap length
distance offshore
nax distance offshoreQ
channel
:ubic yards
'amp
ouse/ Boatlift
Bulldozing
line Length
not sure yes no
ags: not sure yes no ,
orium: / n/a� no
s: �"/ yes
rAttached: yes 7now
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(Scale: I
ding permit may be required by: I Own 61 U j / See note on back regarding River Basin
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North Carolina Department of Envitonment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor glrector
AGENT AUTHORIZATION FORM
Date: —?—
Name of Property Owner Applying for Permit:
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M-As"k 19
0jAIV CY D, & Ia1
Phone Number: O - 5
Dee Freeman
Secretary
I certify that I have authorized (agent) (-"Jk�1A � Ag to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to install or
Construct (activity) 1Zv x r
at (my property located at) --Ls-sT
This certification is valid thru (date)
()CII
Owner Signature
Date

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Page 1 of l
DjACENT i0TAR1AN i_'R(tiY[?'R-1"Y OWNER STATEIMENT
t s�f �� I•:�•
�•-(:`I:tme of property Owner)
-,cal+ert�• iccaved at 1 _`� T ._ - -- .•----------
its' ..scltv.l
(w.iterbody) ('iow-,n andier County)
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t>1r6ttC #/Z-t"?ter.....►3:AC!tl' ik4'tiR
1_ �="tAlliic:nts M !iA.iLU+
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rr !H•,l`.Vl'. t};;• a:we!n1)mt-:t t}i� i It£UToSing at that loUatic n, :end, 1
.'l£:L; raE'. YL`; ��iilV?Ei
:'lit l•� �'..) -�''�ji'Gii+")t:� i0 Itl: �I�JH•J.<<+,
llkSi'R11''1'1[)� A.NJ.►;i R I.LaWING U1i PROPOSE)) )EVE
(7o hr fi112ii;n bt ,7rn1+<r4' t?1Frtt?r� •r,l7tlsir; �f v(:1Q/:nrell"
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T"1a2�t=1 n_[,t n rLI��._f_I� r�•- n_n ; J
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J11formalkin for Proircr•i CS+tia� r :\{'.t`ljin iRi rt'iatt Ptt�pt rt} On'nrt' t.nfc,t�u.tiiotti
for Permif)
tVi:)Airri l:Mtess �tC,71:4t:1['C

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ADJACENT RIPARIAN PROPERTY OWSIR STATEMENT
I hereby certify that I own property adjacent to r,(,�r �G i 'S
(dame of Property Owner)
property located at ! %L 6�
(Lot, Bioek, Road, etc.)
on CAA in—
(Waterbody) (Town and/or County) I
Applicant's phone Mailing Address: 2 �(dCllor
0
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal_
DESCWTION AND/OR DRAWING OF PROPOSED DEVELOPMMNT.
(To be filled bi by properly owner, proposing development)
fhofo xk& `✓i,� I Wall
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i �S N�9h po�n�'Sf
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Adr signature
city/Stowzip Print orType Name
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Division of Coastal Mgt. Habitat Impact Computer Sheet
icant: A,[ S�kmt Permit #:
2/1 te/12
:vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
!at Name
s
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/ortemp
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
Dredge ❑ FilI < Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other
0
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 ❑