56634D - Wells

CAMA / )DREDGE & FILL
1ENERAL PERMIT Previous permit#
]Nev []Modification []Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
,oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC i R fit. j
\ ! , tt { , f Rules attached.
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t Name Y i 1 1 , V' V 9 11 S
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Yf a State AW- ZIP Z,64LfS
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:ed Agent � ` iJ � wlyu �, xS4 . Vr-, a `jwGil'-n t"
❑CW AEW XPTA
❑ OEA ❑ HHF ❑ IH
PWS: ❑ FC:
yes / no PNA /fe—s—) no
f Project/ Activity
,ZES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes
Project Location: County VA,ya /-
Street Address/ State Road/ Lot #(s)
Subdivision K
Pblity SC! KlS ZIP r
e # (I 11L )5' l 3 River Basin 1 x
Adj. Wtr. Body Q`k r nat i
Closest Maj. Wtr. Body V mp 5Nr A
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offshore
Lx distance offshore
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ing permit maybe required by: 50- a4l, / f wUl-ct. ❑ See note on back regarding River Basin r
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8-2011 09:52 From-BBT INSURANCE SERVICES INC [phone] T-210 P 002/002 F-828
AWA
NCDENK
North Carohna Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Govemor James H. Gregson, Director Dee Freeman, Se,retay
Date /12-�ZG /t
Name of Property Owner Applying for Permit:
`.54r-vc_- tA Idc L
Mailing Address:
T7^
I certify that X have authorized (agent)
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits nccessary to
install or construct (aclMty)
at (my property located at) O i• to.. l`�a;.�-"I L
This certification is valid thru (date)
Property Owner Signature
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] Internet. www.necoas'LalmanageTent.net
An Equal Opportunely 1 AR#rnakva AGion Employer— 50% Rec 9a 1 10% Post Consumer Paper

1-2011 08:18 From-88T INSURANCE SERVICES INC [phone] T-212 P 001/001 F-830
ADJACENT RIPARYAN PROPERTY OWNER STATEMENT
(FOR A PIE.RIMOOR YG PIX,1'NGS/BOAZUFT/BOATHOUSE)
I hereby certify that I own property adjacent to -511r-yc- �&)e- #s Is
(Name of Property Owner)
property located at 3 ZO
(Lot, Block, Road, etc.)
on , in S ur-- i , N.C.
(VVaterbody) (Town and/or County) Applicant's phone N. 9/40-5-90 - g291 Mailing Address- 4-4-4-�" Ba-r ' dd Dr•.
NC 21?411
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 / boatli#I / 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.)
�v I do t wish to waive
I do w14h 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 (Riparian Property Owner Information)
for Permit)
_ 44 .3 a ; ,.) cct. r. .11�iyt �C1
Mailing Address Signature

8-2011 09:52 From-BBT INSURANCE SERVICES INC [phone] T-210 P 001/002 F-828
p.2
M/27/2011 17:30 9196541931 PAfa� 02/02
AWALJ-N'l K1rAkUAi`1 .rrurr z nt t V r►vgz-m j A 1 r.rYtajt .
(FOR 4 PIERIMOORL'VG PMUVGS/BOATLr,F7/50ATHOLf.54)
I hereby certify Lhar I cw-u property adjacent is
.S r
's
(itiame of Property Owner
Drupe rty located at
(Lot, Block, Read, cfc.)
on i7 I N.C.
Maierbody) (To1Va and/or Cowatw)
He has described to me, as shown, below, the development he is proposing at tllat location, and, I heve
no cb;cctieris io his proposal. I understand that a pier.'mcorcS pilings I boatlitl /'loathouse must be set
back n ttlinirnUrn. distance of F�fWM feat (157 frummy area of npanr.n access unless waived b\rruc
Of you wish to W&Ive the sntbatlt. you must initial the appropriate blank below_)
1 do net wish to waive
7 do wiSh to waive that satback l2q litetncz t.
PESCRIPTION ANDIOR DRAWING OF PROPOSLD DEVM0PNMNT;
(To ben fUfed in by individual proposing efetvefopmeng
If yo+i h2vc tnbltuions to what io bcin., propwtd, you ioaal %9C: + tbt A1vl;; Tj of COad12t Marta$crnwt (DCNI In v"rinag
withih 10 dayc of receipt of tha aOtim Carrctpondczcc sLoal4 bt mraikA to 121 Csrdin2l Drive XXt. WWMAnM' %, NC
DCM reprastntad•rs can also beconti+cte.d at (510) 796-721 S.
No reapo-g is ermsjcred the:Mne as rTo obir:uon it 2H have haan neMed 6y Cer M54 M411
(ltrformation for Property OwncrYApp)icant
Applying for permit)
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Mel4ng Addrrss
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3�gnaturt> � D to
atiaw k'repLersy Qwaer InformaitionJ
S qnalmm
print or Type yam:
14.E �? 3�0 3
TakFhoae Wm'oe-
127 Curdlnet Drive ?9t Wilmington, !North Carcllna 2840S-305
Phonc: 910-796'Z151 FAX: 910.395.396,t', Internet: wmv ilcccastalmanegerrient.met
ancgJ;g0;WfWN1'/1Orma0veAasmEVore,-E%Recyoe 110%AwCwmmrrPaw
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Division of Coastal N19t, Habitat Impact Computer Sleet
Acant: aMi A, WW�
-2-1Z-111
Permit #: 610 5U 1� 3` i
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
kat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
l `
1 W
Dredge ❑ Fill ❑ Both ❑ Other
V
ADredge
❑ Fill Both ❑ Other ❑
� O
Dredge ❑ Fill Both ❑ Other ❑Alcli
Dredge ❑ Fill ❑ Both ❑ Other ❑
t�61)
U 61
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 ❑
'1 r_ q6D
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B AND B MARINE GVNUTMIL; I Iun
1168 COREY DRIVE
WILLIAMSTON, NC 27892
DATE Z
TO THE
PAY
QRDFR OF
Ix
Wacwvla Beak a dvlalon of Walls Forgo Bank N,A.
FOR 1 5W 33 0 `" WlS lvi�,) J�,
II'00 10781I' i:053000 2 L9': 20000544487001"
aV1%0
66-21/530
BRANCH 77a:
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