56693D - Randell

CAMA / � DREDGE & FILL
'IENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources h
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC /�a0 v 0 G
[Z) t[iles attached.
Names_ : y�(� %� ,✓ d 4 l L Project Location: County L iZ w r f wi r K
&00/< L "')'7r W�J ? CI A.' Street Address/ State Road/ Lot #(s) _5'e r7 C
tw State W ZIP
(_ _ _ ) 5 5'3 Fax # L_ )
ed Agent l ►/e r f -b v c,C5
❑ CW IL11W ,❑ PTA ;.ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / no,. PNA yes / no Crit.Hab. yes / no
Project/ Activity ?,,e,2 . _C -e tX , {
l%ark d Ne.°-✓ L17o9Y1Li
ki ia..&h /Tr ',� r
Subdivision
ZIP
Phone # ( ) River Basin wiz
Adj. Wtr. Body C,q,✓A4 0t (nat
Closest Maj. Wtr. Body �� /I/ G✓
-e #-; P
(Scale:
----
■■■■■■■■■■MEN
MAEM■■■■■■■■■■■■■�■
■■■■■■■■■■ME■■M■■■■■M
■Y■■■■■■■■■
MEN■
1111111111ME■■
N
ON
Y■�■■■■■■
MM■■■■■■
■■
■■N
■m
■■■■■■■■
■■■■■■■■■i■
■'
E
IN
MEMO
-
■■MME■M■A�ll��
W
■■■E�
■E�/
I
■■■
���
■E■
'�l7�RI■■M■MME■
l�M�/lHE■■■■■
IMMYM■E
M
■
■■■EEEMiiillilli`a
■M■M■o
■■
■
��
ENE
■■■M■■■■■
■MME■
soon
■■■■■■
■
EEO■
■■aE■■m■■I■■
■
■IIE■a
MM■�iEM■E■
Now
■■MMMMEIN
�I�E■�iMM■M■■ME■M■
■EMMEE■E■E■■
■E■
iw
ME
M■■MEEEE■■M■MME■r'
I-
■EEMIE■■ME■E■■MM■
E■MEM■MMM
■■■■■111
ONE
M■■■■■M■MI■■■■m■I
IE
■■■MRon■uE
■M■■1�■M■E■■■
■EEO
■
MMM■■■MEE■■E■M■■1IM
■■■M■EMEE,■■■NMI
IEME
■■■MIM■ME■■■■■■■EI
P
ISBN!i
VIM
remm%manani�
/■■
■■omm
IEMj■■■
■■
I
tz■■MEM
EI
immismommii
am
■ME■■■■■
I l■■
IN
■■■
I■■I
■■■
.■■
L
�_
=---__MI
_;
■Mnu■■■■
I iM■
IN
■■
IMMI
■■■
�■■
it
IE■MM■■E■I
l31lZYwE■■■MERLdo
■■omomEmbi
M■■I
IN
AE■l■Mlaii■M■I
MEE
■u■■EEEn
HMaiMi■■E■■■■i��
■■■■■MOMEN
■■■■M■■■M■
oil
MEMW■EOMNI
ling permit maybe required by: Ore p , , Zs L 4dO/9C X ❑ See note on back regarding River Basin i
S J4 Lie-h,& i, /,-- AJA-f A, Ali . d �, ..i/ - /i A :;• I I / 1 -1

LIFT
FOOT
FRIN7
5 p 114r,4) t S ZG✓e,c S� T''
- - j3 n� r G F r 7o � CG e,4 vie
\Eti'4' P� c..R
1-0 6OA7-e.z U'4V .
NEW R.:.NiF
FIXED WALK WAY
SIDE I I I 10 ' SIDE
Fln y 7-�9.
z- A' o!/ o
�p,c�I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOI/SE)
I hereby certify that I own property adjacent to M hk G R-*4,6el 's
I (Name of Property Owner)
property located at $ 7-OA)
(Lot, Block, Road, etc.)
on le &0 , in c7Ge,-9,,0 t'Sl. Ae-4� , N.C.
(Waterbody) ('Town and/or County)
Applicant's phone #: 9fa-36?-4,2§7�ailing Address: or3oX ��3Z
1t.,41 o c_
7
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
�? 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)
£SOX /9-32
Mailing Address
s_" l 1 nm ,vC- 004 s
(Riparian Property Owner Information)
Signature
('itv/Ctata/7in

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to M I le->; 2,a,J ID cf., !I 's
(Name of Property Owner)
property located at g
Block, Road, etc.)
on / C_ cj , in pG P!a-AJ /s e, Sews t , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: !�/D - 96-7-61YZ-Mailing Address: Pages 53Z
>44
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
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
� ► Try �� -�-t�
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
Signature

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 3- 3 d 1 I
Name of Property Owner Applying for Permit:
AA I
Mailing Address:
g z c,j ti l WK ► :!!5 —ice sT
I certify that I have authorized (agent) (4 J en;w' DrxlS to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) f 3cag7�(�
at (my property located at)
This certification is valid thru (date) 6 — //
Property Owner Signature
Date

plicant;
te:
Permit #:
s"�� �21 -0
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
ind in your Habitat code sheet.
bitat 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 FINAL Feet
(Applied for. (Anticipated fir
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and
restoration or temp impact
temp impacts) amount)
L
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other(
Dredge ❑ Fill ❑ Both ❑ Other j
2 1/ 0
z /U/�,
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 ❑

.iihhZt OOt bZO :1U95hOt E50:' ((�Q)
69VFk VNI)OLIVO HIHONM:
a
see_
if S/9sb-99
5