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Home My WebLink About60723D WellsCAMA / �--bREDGE & FILL / N O • 6 C ENERAL PERMIT �1 Previous permit# ew [-]Modification JComplete Reissue Partial Reissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �}, (� (7(� } ,' 7 `7 J4 , %— ules attslched. t Name Project Location: County �,'if� 21 t 45 Street Address/ State Road/ Lot #(s) PC I O T' StateNL ZIP (11 2L SFax # ( ) Subdivision zed Agent ';ftg k nQi�( Lw,�j City-O( lL-v1 +.,�01 Nr ZIP ?ktf i Cw EW ETA fAS F! PTS Phone # (_ ) River Basin OEA HHF - IH ❑ UBA ' ] N/A Adj. Wtr. Body 1 VG L 1'Y (nat PWS: �:] FC: yes / no PNA / no Crit.Hab. yes / no Closest Maj. Wtr. Body C bf Project/ Activity VP-1 V 611L BLI LiCN �'_ Ot l 0Q(A1— t4 fom ii,A'fV1p (lock) length X (Scale: pier(s) ' — r length _ _ - umber w ad% RiPra P length r" flt-1 tj vg distance offshore]�.— �N(�rv�iuS , iax distance offshore -� :hannel -- --- _000 , —- ubicyards imp )use/ Boatlift _____ _ It t- - - �i.OPIT l h Y i ne Length ti not sure yes gs: not sure yes I 11►7 , T ,rium: n/a yes— , --, Ue no t j —� — — Attached: yes no ing permit may be required by: PEN OVYL ❑ See note on back regarding River Basin g g ' SDecial Conditions (oN01T��IJs (�� ({ , (4 0�_ �Z� j I► �L, �� Division of Coastal Mgt. Habitat Impact Computer Sheet cant: �J \ (2'� VJ �� Permit #: ( 0 7 Z3 tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement d 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/c temp impact amount) Dredge ❑ Fill Q Both ❑ Other ❑ t �� Dredge ❑ Fill ❑ Both ❑ OtherC� ? 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 ❑ ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIERIMOORING PILINGSIBOATLIFTBOATHO`USE) I hereby certify that I own property adjacent to J� �-- i-h 1J e� )J� Is (Name of Property Owner) property located at (Lot, Block, Road, etc.) 1 on in ?7n dex , N.C. aterbody) (Town and/or County) 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/boatlifVboathouse must beset back a minimum distance of fifteen feet (151 from my area of riparian -access unless - waived by me. I do not wish to waive the setback requirement. I do wish to waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) S2 D.;-+ - T....o AT..-. - ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIERIMOORMG PILINGSIBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to _ ';Aj) f- �k 0 el 55 is (Name of Property Owner) property located at (Lot, Block, Road, etc.) on in k dey— , N.C. aterbody) (Town and/or County) 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 waive7b-' . I do not wish to waive the setback requirement. I do wish to waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) See a-1�}ae�� Ira �i Print nr Tx, A7..... . 'Pro &?ed 6Y !D od 32' "'l 104 3x 16 1;7,aimP de -lb ytvPj-� '06-- ►'a)a' 1%ro Peed IAX 1,2- ym4( Cf :o ' ' t 16�7� +� s I� F�c Letter of agent I W + r tf We -)Is have retained Mark Clements DBA, Clements Marine Construction Inc, to make application for any and all permits needed to start construction on the work requested for our property or properties. By allowing Mr. Clements to make such applications I do understand that this will in no way relieve me of any obligations to perform all work according to the building codes of North Carolina, CAMA, DWQ or any other state and or county ordinances. Print nam--e��jj -- //,, Signature (e1t0) Y71-32,�5 date Contact information