54514D - Makdad

'CAMA / ❑ DREDGE & FILL
3ENERAL PERMIT Previous permit#
4jew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
irized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1ZQ�
❑ Rules attached.
it Name jatNo Project Location: County 1-362Vt�.'Sl ll fC �G
vo
( kV 1 � _ l'T�JV) State ZIP 05
(-f - (c�; �%Fax # ( )
:ed Agent 6—NV� & t L-1 — TCe-t- )ti
❑ CW C3EW C!-PTA f;;TtS ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Street Address/ State Road/ Lot #(s)
S SG Z C y (-t l
Subdivision
City G'�/� K ISC 691u'% ZIP Z'S-le
Phone # ( ) River Basin 0*C
Adj. Wtr. Body /9 ( C.'J (,cJ at
yes / O�—; PNA ,yes / no Crit.Hab. yes / no Closest Mal. Wtr. Body (�
f Project/ Activity rl i v 011� /..g OZ-
0 `>•i
(Scale: -
ock) lengt� 1 � N
n(s) i ii -" i X— '
>ier(s)
�ngth
amber
d/ Riprap length
g distance offshore
ax distance offshore
hannel
bic yards
np
ise/ Boatlift L .a ( Z
ulldozing
i
n
e Length
not sure yes
s: not sure yes
•ium: n/a yes
yes }�
kttached: (16s)no ---
ng permit may be required by:
❑ See note on back regarding River Basin rt

kvxw
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) v`' �r �U� to act on my �`
behalf, for the purpose of applying for and obtaining all C Permits necessary to
install or construct (activity) Ler, Or'e,�ZA;ct e4jvj ADa-t—it Icr
at (my property located at)
This certification is valid thru (date) ,o-Z —.7y / 0
8/11/ /o
Property Owner Signature Date

/C1D/L191CI 14:Z)0 zIaliDDO rUDLIUWUKKS
04t-us tti•N JoW Kbsi 9*846-33603-2- 279w"
rHut
P V2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING P1U7VGTB0ATUFTBOATNOUSE)
1 hereby certify that I own property adjacent to -Ci i c ' __'s
t',l+li� c o[ ropeRtr �sr)
property it"ed x t(V4
(Let, 8194, Read, etffc.)
on , in 1. L-k v�hkc ,)&d N.C.
(Watcetwdy) (Tows and/or CAanty)
Applicant's phone M: M.-1j6,�„��,ky„�,, Mailing Addreaa:,.�p �;
He has deserihed to me. as shown below, the devc1opment he is proposing at that location, and, I
have no ohiectiona to his pmpnaal. I understand that a }tier/mooring pilings / boatlift / boathouse
must be set hack a minimum distance of fifteen feet (1 S) from my arc& of riparian wom untcas
waived by mc. (If you wiab to waive tee setback, you moo talthl the appropriate blank
below.)
1 !mod wish to waive
191 wish to waive that setback requiremalt.
DE.WRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Ta be frl/rd in by individmil prolwssing dtveispownt)
(Information for Property Owner Applying
for Permit)
Mailing Address
J/
G'ity/Stmei7.ip
(Riparim Property Owner Inforinatiea)
+�:L::,:
Wo�tune_L
✓
nd-
�.._._ Print or Type Name
1Aw 1" I .. a- 0.n - _4 .n-i/-)

0-WH* 09:53 Joel Ums 9*846-M v> P 213
ADJACENT RIPARIAN PROPERTV OWNER STATEMENT
(FOR A PIER/MOORING PlUIV SB(1ATLIFTBOATHOUSE)
I hereby certify that 1 own property adjacent to / L12. d s
(N a of roperty Owner)
property located at - 51"PM rr.. .2
(Lot. Block, Road, etc.)
on in "
(Waterbody) (Town and/or County)
Applicant's phonc N.1,36 1%.�' ,% 1 Mailing Address•
He has described to me, as shown below, the development he is proposing at that location, and,
have no objections to his proposal. i understand that a pier/mooring pilings / boatlift / boathouse;
must be set hack a minlmwn distance of fifteen feet (I S) from my area of riparian access unless
waived by me, (if you wbb to waive the setback, you must initial the appropriate blank
low.)
I d2 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 development)
(Information for Property Owner Applying
for Permit)
P/) 2'rt;-1 ylr ----
Mailing Address �—
City/sla te/7.in

I I /1 \ n i ,.. I

Division of Coastal Mgt. Habitat Impact Computer Sheet
licant: ,rY1 r*- K--OA-0 T-G-" _ _
3117/ 1
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremenl
id in your Habitat code sheet.
itat 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 fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
1r
Dredge ❑ Fill ❑ Both ❑ Other �
�1�
`-�`
Jlrc
iINN
Dredge ❑ Fill ❑ Both ❑ Other 12r
F
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 ❑

BETTER BUILT CONSTRUCTION
PH. 704-385-9853
886 TRAYWICK ROAD
PEACHLAND, NC 28133-9443
DATE 2 " i' ,_ /
PAYTO THE
) /
ORDER OF ;°lJ l_.- D L�
mnl I —
mBRANCH BANKING AND TRUST COM7Mw
1-800•BANK BBT BBT.corty
'Y.
11'000114461I■ 1:0531011 211:0005 216 27 296 1u■
11446
66-112/531
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