56656D - Tucker

'CAMA / DREDGE & FILL
PENERAL PERMIT Previous permit#
New Modification 'Complete Reissue Partial Reissue Date previous permit issued
sized by tl� State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0 G
III attached.
It Name 6 kC /C- Project Location: County
Street Address/ State Road/ Lot #(s) S 2
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yes / no
PNA yes / no Crit.Hab. yes / no
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Subdivision
City or rs),* •POiDC-4 ZIP 2 73,
Phone # ( ) River Basin L ie^i �
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ling permit may be required by: (J t-,O,9--.Z dco -&aae4 ❑ See note on back regarding River Basin

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOOREY'G PILINGSIBO�ATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 61 m G c r- —IS
(Name of Property Owner)
property located at
t-o' 86 'Tkc- des
52 LJ3
(Lot, Block, Road, etc.)
on
5,911kA -in 0, - D(-'V�Js W' Ck , N.C.
(Waterbody) (Town and/or County)
:� ��� � Mailing Address: P 6��) 43
Applicant's phone #
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)
A tf aC4ed
(Information for Property Owner Applying
for Permit)
Co. &i �43q
Mailing Address
--------------------------------------------------------
(Riparian Property Owner Information)
A���� d3Signature

job
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIBOATIIOUSE)
I hereby certify that I own property adjacent to T M TU e-C— IS
(Name of Property Owner)
property located at t 9 4 i rJ Z W 3 c"` '
(Lot, Block, Road, etc.) /
nn Q in T B. f'UNSUJion C1�. , N.C.
(Waterbody) (town annd/or County)
s: ~�7�i Mailing Address 7q3q
Applicant's phone Oo �O-
0TEAC 1990
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 (Ripa!��
Owner
for Permit) ;4 A
P0, gox
Mailing Address _ Signature

licant:
3:
5 / /�I
Permit #: S-' p rf b
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
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 fina
disturbance.
Excludes any
restoration andh
temp impact
amount)
©
Dredge ❑ Fill ❑ Both ❑ Otherx
7,20
Dredge ❑ Fill ❑ Both ❑ Other A
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 ❑

RYAN D. COOPER
NCDL 8375610
PH. 910-443-4829
P.O. BOX 1393
SHALLOTTE, NC 28459
66-7704/2531
DATE S.-/"7— / 1
9342
PAY TO / V / V $ 2-0THE ORDER OF
t
�..
� DOLLARS � a�
State Em to ees' Credit Union®
r"yI,c?j^,CyL Supply, North Carol a
81
MEMO IS Z W J \ � l/I, O C.(, ) N.
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