57344D - Tucker

LAMA / DREDGE & FILL
130-4ERAL PERMIT
New ' lodification Complete Reissue --Partial Reissue
Previous permit # f �(! ( S6 -
Date previous permit issued-4/
Eed by the State of North Carolina, Department of Environment and Natural Resources
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7//-2 GiGD
QRnfes attached.
Name C-leeto e_ Project Location: County?,Q y,Jfw i-C t � G'" — 7
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.ed Agent
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❑ PWS:
❑ FC:
yes / no
PNA yes /.Co Crit.Hab. yes / no
Subdivision
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Phone # ( )� r/ ' River Basin L�r
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ling permit may be required by: �C�9^� El See note on back regarding River Basin
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORIAG PILIAGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 21, 0 T C.kCC` is
(Name of Property Owner)
property located at L.b+ ? � 71,ye ke-so ' `L ) � � W -5rA
(Lot, Block, Road, etc.)
on 00 Se?l)N Cj-'ee- , in �rZF� Ls-u jstx)'ck— , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:��'J�g-��� 1 Mailing Address: 1 %0, PJ0X I
O1S,/, IU �= 7 8N ��-
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 APiD/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
F�01190K ` g314
Mailing Address
(Riparian Property Owner Information)
. �� J�
Signature
n`TR k►i -i orl. a
Pilo I- -t

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Ti � :112 ck� r is
(Name of Property Owner)
property located at L-O O like-
V"Q;. � t
(Lot, Block, Road, etc.)
on _�I SC)0 tJa &�k , in © T-B, &(V/,J.S Wl' C)�- , N.C.
(Waterbody) QQ (Town and/or County)
t� z
Applicant's phone #:10 52 0-7,51 J Mailing Address: RO , I (M l q J L-f
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)
Ro l
Mailing Address
(Riparian) Property Owner Information)
[VV)
Signature
('I) -T R . &) ( 7 C14r c7
-Tat; ,A / /1,4 a 1. ee�,—. —

Aicant:
te:
Permit #: — 6�� C' 6 —'2)
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measureme►
nd in your Habitat code sheet.
Atat 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 fin
disturbance.
Excludes any
restoration and
temp impact
amount)
O il/
Dredge ❑ Fill ❑ Both ❑ Other
S
j
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑