54582D - Flowers

'LAMA / DREDGE & FILL E
ENERAL PERMIT Previous permit#
New ❑Modification _-Complete Reissue ❑Partial Reissue Date previous permit issued
rized ate of North Carolina, Department of Environment and Natural Resources
oas .. es...rces Commission in an area of environmental concern pursuant to I SA NCAC
Rulet attached.
t Name 1i ! Q C Project Location: County C\KS(CW
Street Address/ State Road/ Lot #(s)
f,
State ZIP l i I G I 11+t�-
(� Fax # (_ )_ _ Subdivi ion
zed Agent _ _ _ ._ _ — City ZIP Z
1
d cW = EW PTA []ES PTS Phone # O River Basin
OEA J HHF IH G UBA El N/A 1
PWS ❑FC: Adj. Wtr. Body Cl i nay
yes i� no) PNA yes / no Crit.Hab. yes G
Closest Maj. Wtr. Body
Project/ Activity
length
pier(s)
length
number
ead/ Riprap length _ _
avg distance offshore_
max distance offshore
,channel
cubic yards
ramp ��[[
louse/ Boatlift xg
i Bulldozing_
r
line Length
not sure
yes no
ags: not sure
yes no
:orium: &a�
yes no
s:
es no
!r Attached:
� a��d �n5�z�l I ►'� w -;
(Scale:
ding permit may be required by: ` U I WY4 ❑ See note on back regarding River Basin
k
u 11 IA P A h ter, I C..L. L n - ,1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
(czi� s
I hereby certify that I own property adjacent toZnA�f((NaProperty Owner)
A
property located at
Yt,ock, Road, etc. 7N.C.
on (pn
(Waterbody) &,!kL—
''dtt/or ! _ n'ty`)
Mailing Address:
Applicant's phone #:�_ �Z7
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
do wish to waive that setback requirement. /O /U %¢�
f------------ ---
- -------------------------------------------
--------------------- - - - - -
PESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT,,:
(To be filled in by individual proposing development)
r
1.
------------x
(Information for Property Owner Applying
for Permit)
Mailing Address
i
- -- - --- --------------- ---
(Riparian Property Owner Information)
Signature
A

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
�--Ihereby certify that I own property adjacent to s
_ �/ (Nam f Property Owner)
property located at4 1 cY� , ,
t, Block, Road, etc.
on , in 24 C , N.C.
(Waterbody) (Town and/or nty)
Applicant's phone #:c A 40 Mailing Address:
C �-k,\16N-j
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
36.. .I do wish to waive that setback requirement. ,
---------------------------------------------------------------------------------------------------------------.----
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT.:
(To be filled in by individual proposing development)
L7� _-4
--_-_ ___a________________________
(Information for Property Owner Applying
for Permit)
4 � k �t �A 2-:�- ff+. .-
Mailing Address
n t - l.- i . .
.------Y'---r--.z--- iry---- ----------------
(Riparian Property Owner Information)
Signature

C Division of Coastal higt. Habitat Impact Computer Sheet
plicant: �1'1YY1 — Permit #: P 5`- 1Zz
te: y
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
:)itat Name
)w
iW
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated renal
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)
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
jull
I
Co
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 ❑

JIMMY R. FLOWERS
LIC.650617
1270E N. BRIGHTLEAF SM THFIELD, NC BLVD. - 934-7332
27577
PAY TO THE N L/ ) >W 1 v V-%
ORDER OF b
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O�For cal91Check -963i6257 Call. too)
��� Local919-963-6257 too)
BANK
Toll Free 1.877-963-6257
ANK �F, _
MEMO
1:053 LO50591: 065 106 1206
V
66505/531
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DATE
3132