76058_Summerfield Community Assoc. C/O Jerry Cason_20200713

[L
1; CCAiwA/�D REDGE & FILL T om/ No. 76058 A 6D C D
GENERAL PERMIT Sb 1 1 �05c1 n Previous permit# ,� ,�
I]New UModification [ ]Complete Reissue CI Partial Reissue Date previous permit issued )1 a /o'
As authorized by the State of North Carolina,Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC •e5), 'Z C 6/4°
G'r/e, ...-7-e H y � 2_, (iRvies attached.
Applicant Names t.i -w eL Fi 9z•YJ CO'4'i k 0--i 1-1..,1 Aliter.oject Location: County i,..d ,c./7i e ,t,/ Co.
Address �i.A•R.'6-az r j t, Street Address/State Road/Lot#(s) p i e-/� z4..•41
City � +rL. State/IC ZIP -Z-7r?-I2 2 S
/L+'9-rl Se-ti`r cM, > c r�-rc►-t CL/� lotz.vt. �?l4 rig
Phone#( )"9VC bra _E-Mail . Subdivision -mev-1 Pit.t1-0
Authorized Agent S Aw 4 dl45 ^2e C C zi I N--- City .�? -z _____ ZIP 'L:7 3-7 t,)
Affected Cw 7 EW ETAS Phone# ( ) River Basin - c.,?"
ElOEA LJHHF IJfH [JUBA ❑N/A
AEC(s): n Pvvs: Adj.Wtr.Body -f3 rn•-t C#s' S t`t- '(n,�t tan_Arnim)
ORW: yes no, PNA yes / Closest Maj.Wtr.Body L itr. S c_;j n•
/
-
13t1- 44"7P i
Type of Project/Activity .'i2.6�l.4—e-r- *„ '1 5 -t v, -r $3 a'c 44 -- , - ,,I..,..,
:.,c - o lei . .9-2-5 v i'f Barre-- e'-i-I tiri.4 .2i 3•t a' Q Th t,--r-sf- •.z: Q 4 A't g (Scale: j '_2 / )
Pier(dodo)length
Fixed Platform(s)
i
Floating Platform(s) __? I �"';'_'' , -/ - i •''k) . ; . ;
Fingerppier(s) oc t./ i i ,
Groin length t
ZG' - S' �. !
number I
1
Bulkhead/Riprap length _. '
�S lam i
.
avg distance offshore
max distance offshore i4 '�� a t
- r--r > -_ .-Cl `L TA_f0-ra .pjE +ttl.t V
Basin,channel_ . - 4— i as +-1 el 1 $
cubic yards 1 [3.7z, / . -
Boat ramp 15 7z v.
Boathouse/Boatlift_ -4CL _ 1 T- -T
Bead,Bulldozing
Other �_ ... f) .
- - ?_ • 4 74-7-7" , . . • ,. o_a s-, , 1-`9•Li-- ir--n-t. , ,
ccu..?/ 1
Shoreline Length 32.7
I N ; -
AV: r -_not s{ yes ;
Moratorium: n/a y� � + .
S
Photon yes - :% 1 - "�" E.n- r9 .cr-+. .
r2c.19
Waiver Attached: no i _ 1 - _ _ 1'Xr$
A building permit may be required by: j -i+-J- , / c, i- b T
h, a,l
_.71 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
dSpecial Conditions '��*h y !-Zr 'Tv t�Cn�T:29 J•. e.) �•
Note >..! )1. ig/71--l ��v>✓ y-,Z kV. C. .
'-`fir+? 15 - fita e' -sue P.e- /t:afS,../ -E iev 5 rri 44'7 e-j77-I-
•
Agent or Applicant Print e
Permit 9 icer's Printed P ame
Signature **Please read pliance statement on back of permit** Signatu - ..
6t/1d,v � Ail,�-_ '7 3' 2 �9 • 'a0 - •z.J
Application Fee(s) Check# Issuing Date Expiration Date

it/t1 12)2-?CAq-t-i--t
0. AMA / REDGE & FILL 7CJ.rL1o,,/ No. 76058 A CD C D
GENERAL PERMIT Previous permit# ,4 lc),
)C ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ) bop
As authorized by the State of North Carolina,Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 6 )/-- •ZS c)C)
/,, e7- CX7 26i,,q eN Rules attached.
Applicant Name S L.,Mel)ea.?i 51,9 C W i-t -�4 .//,ite'roject Location: County ,t,/ co
Address fi z r aura l!, Street Address/State Road/Lot#(s) of-1 ,.,/G •.,
City Pole-. State t1C ZIP G 1,I c) 7'2_ ,- 5,.,n-frvi Fi 4ti.0 e"dH44,. i' A P
( s .r
Phone#( )67Y fi .� '7,v E-Mail Subdivision -.6vrnM t-gL j'r(tZ..p Authorized Agent S A44,''7 els "2,e7, /.192.1 tic City '--'P ZIP 1 ,c ? O
Affected ❑CW 7 EW 1JTA /S ITS Phone# ( ) River Basin },�;
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑WA Adj.Wtr. Body,f}L"43t=f+'1r12-(.ts Br an /unkn)
❑ PWS:
ORW: yes �no.� PNA yes / Closest Maj.Wtr. Body ,3F � St �0
P i
Type of Project/Activity % `Pl4-at- jle3.-..r Si,) ,'a41.J..— ,- ,4.¢a( t
;,4, zo i4 . ,6dzS v WE -F 1. -7./ Piert r e- -�" -> )214^it la (Scale: )'=2,3
' )
Pier(dock)length __.
Fixed Platform(s) I
Floating Platform(s) j
Finger pier(s) 3'X L/D /
Groin length I^24— , S
number-__z_ -
Bulkhead/Riprap length ���Z 4r
avgdistance offshore
"7 L_. s �z'r'
max distance offshore i j "--- � 4-Arl TAA.� P2 'u+t7btSt4,
Basin,channel / j `1 i"A'ti'"ri 5c_t )3y /J.jv1404 t -3s
/ .cubic yards Boat ramp 1'� ,t'2D rBoathouse/Boatlift ' '!0' -3 'o � °3.Beach Bulldozin ' 'g y t "C Gi)
Other ��� � X _���1, • i�p 91 l�,�lCrt±ir'Shoreline Length 3 4 i
SAV: r not sur� yes not. ; k
Moratorium: n/a yes �+ r t 6v,,z4.rr' 'Q CAL.0
Photos: yes no "' G ,1 ---r134 ,,_-
es Waiver Attached: no Vwr,y
A building permit may be required by: L,/ 41-i+4-i -0-0,/ ev• b . ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions y /5 for iv & ; ;-Z' /•d J/ it r,'-f ?i,.)w L
ia-r-H 5 - '1-0 eXer."6.0 1/.�_`GLi Gat S,.7 76'14/5 r71 Lt ii',7 -/.
E v
Agent or Applicant Printed Name Permit ficer's Printed 1 ame
'
Signature **Please read compliance statement on back of permit** Signatu
'va,vt--x7 ,vlam— —7 •/ 3• z--47 9 . - • 2_.o24.7
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the
Wilmington Regional Office(910-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves: Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/I7

H k:
❑CAMA / i DREDGE & FILL0
w,L 1 ( c•l�% No. 76058 A '� C D
GENERAL PERMIT -CO �'5 Previous permit# r�
> Z New ❑JModification ❑Complete Reissue El Partial Reissue Date previous permit issued t ; i-
As authorized by the State of North Carolina,Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 5) ) '2 C vU
6 /J �.;1-c it-/ . ,.,-.=-;•r".. "Rules attached.
Applicant Name -�tJn' Z F!e- 0 ( 4- N t-/ i 1, 'zeroject Location: County i.,-.4---5;.)--7,..,IS-r-a,-1 Co,
Address 5 'v-i-►-1 6'z r&- t , Street Address/State Road/Lot#(s) Di t ,4-/--- ,.-)44.--(-7
City ,26-2C..... State t'( ZIP -7`)`7 ) 7 2 (-•-• S _----, �/r 1-7 ti..0 /v,-, - . 17‹."17 r").
Phone#( )9vC•v-,-- E-Mail Subdivision �M�-,f..,rz f,1 t L Q
Authorized Agent w Lir ,S Qti.
l) /1'1AZr! - City : -)„tyz ZIP —L79-7 0
❑Cw piEW PTA }ES Phone# ( ) River Basin A,, ....4.0-,
Affected OEA ❑HHF ❑IH ❑UBA "❑N/A
AEC(s): Adj.Wtr. Body ')-t /3 r=r-i' z C t- 3 •`� .(nat an /unkn)
❑ PWS:
ORW: yes / no) PNA yes / rio Closest Maj.Wtr. Body A - (111/-- Sc._,..�.-�
3r 'r- 2AP i
Type of Project/Activity / r/n-e t= r, `, 5 p,i--i ,, -, 9,7 1-1-,-.92.,ul,e-f;,, ,_ i"�--),;,z .•1,)
2,-, ; /.z.S J ;'EP1/1Z�- L ,,,r,-i ,p't-n A ,7 r r l-1T- 2M^'l /' (Scale: ) -23 ' )
Pier(dock)length
Fixed Platform(s) I
Floating Platform(s)
F ~� T ~
Finger pier(s) 3 x Y D
Groin length /-2 r k 3.c.-i
number -
Bulkhead/Riprap length ����� >4. •y
avg distance offshore \ S T'1 --lax,orn-c,,r
max distance offshore 10�. Fv st r-0.•-Y2 ri lr } F►l'rr •v41$!v
Basin,channel - j f }3u�^*-•4-C -1-1-L/----r 1•...
/ I tee' 4 13I ilih It r��
cubic yards . •
tom/o�� .Boat ramp lc , -2 J
'
�
Boathouse/Boatlift , -4 i . .--► 'PC r= � L,{ ' I�4dv,ld, '
Beach Bulldozing i QY�L c i� ti `� ,G p r},�
Other p --ii"-r- '..X��
9 Q
�.1.fE�YT _�_...-. j7�..,,
Shoreline Length DI .,1 4, a I
SAV: -not sure yes no _.. ' 0
Moratorium: n/a yes n• Q T
Photos: yes no / t j l _L P d_c
Waiver Attached: es no ¢ 3'k 5' ,
A building permit may be required by: 4//1-5,.,Lv 4-)y -,4-o ,/ ciu• See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) Nogg-
Noottes/Special Conditions - -L s, "-Zvi' ,v exc&1,"2 /•d /A/ /-> 7G//f r /1I 't s-/. `). e. .
-
Z�-r '-1 S '- I. --- ,-..XtG'� +- 2.4.2A— -,0ii5,.- t1e/5Tl!/h I_ttiiri7-f-1.
El.z--,- Pve.
Agent or Applicant Printed Name Permit Officer's Printed ame
Signature **Please read compliance statement on back of permit Signature
CAL, U 4-z;7 Al lf4-- "--7 •/ • zU l7 . -Z U • Za 2.J
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the
Wilmington Regional Office(910-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves: Carteret,Craven, Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
40I S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

0 CAMA / —DREDGE & FILL -.), -,., ., -1,..41,./ ,,,,,,_,,
No. 76058 ABCD
GENERAL PERMIT Previous permit#
> '' New Modification Complete Reissue __Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC .
Rules attached.
Applicant Name . /!..-- e- 1) Project Location: County
Address -":"• , ,7 ' / . -, )-- -0, Street Address/State Road/Lot#(s)
i .
City State .• ZIP
Phone# ( ) E-Mail Subdivision
A.
Authorized Agent City ZIP
LI CW EW PTA ES 0PTS Phone # ( ) River Basin
Affected
0 OEA HHF IH UBA 0 N/A
AEC(s): Adj. Wtr. Body (nat /man /unkn)
D PWS:
Closest Maj.Wtr. Body -ii •
ORW: yes / no PNA yes / no
,,,;(,'4./"I'l P;-
Type of Project/Activity 7, --'''' - ,- --"-- ' • . j2.,:1--, ,---1.-.,,-„,-) j,1 .1.1-‘0.42 AK-1.. I,-, '-?:---*,, ,
"-a 4/.;LT-/viet, i r rm.) .;7t1' 1 i) (Scale: ) .: 7....2 ._ ' )
Pier(dock)length
-7-- _,
- -.
Fixed Platform(s)
_
.41 / - ;_, ' .10.,- , - - ,._:.Y.,I--1_-.) - • '%,,. .
-.....4..:
Floating Platform(s)
I .
. 1../
_ _
Finger pier(s) L. ..+, ..'_/ ./.,
_ . I
Groin length ) -.,. ,.,.- /_ ...i....7 ,
number , . •
,--_
Bulkhead/Riprap length -.0
' /
avg distance offshore -- -
; "C. C 7"Ci.771-1 I
max distance offshore •,--1r...-) T-4.4 li. I t .-.. 1• 14.4.1 41, .
Basin,channel . illict. Pvc, t...) 1-14 et, --,
,.(, . •-,-,--,,c-:,
. -___ _f___j_.__ .,,N_. ______4_____ __________
---i-- •
cubic yards
1 ; •
Boat ramp '7 .
_ . .
f;--7 .
Boathouse/Boatlift * ••• -' .....# .; ---.= 4 ''‘'-z ;_-" i k, -, if"-- ii--14.4-; '14.4-.L.
. .
—
Beach Bulldozing , ,
t--e.,,,-fr''----- ,,,:,
-.:....i)
4..... ,e- 4...)
.1 Other ,
•>,t-,=..k f-rl- /
- ,--,/.3 ,....., P r";7-$il..t. .4•'",k-
er_00 t-0 6 I-) ; 3-r-
" • #..--"Ii...j ' 4 ..\•, t.,,,,,./eh-)
1. 1 LII
Shoreline Length L, )
SAY: not sure yes no ' . h.. 7 -
. . * , '0 . I AL .
Moratorium: n/a yes no ,
1 - ...
,i!...p..4,1p,t ,-- ? , ni c
Photos: yes no ' , -•_____ ,, •„. ..° I • i e.
... '1'>-V.V.Z".44 j,...
, : : ' .1 .
Waiver Attached: yes no __ crA
A building permit may be required by: ' 1 ' • . Li See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions t
`Mk -• ',MAW 11•• —_
) -' -' '. ,"
Agent or Applicant Printed Name Permit Officer's Printed Name
...."..‹.11r;„
Signature **Please read compliance statement on back of permit** Signature.,) ..-
• ) .12...,:;) / • - '
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the
Wilmington Regional Office(9 I 0-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

Division of coastal management agency form for permit applications
5UNIMI f CbrotAiWiry (} sob, owner of the property located at:
(Name of Property Owner)
Summerfield Rd Roper,NC 27970
(Property Address)
Hereby authorize Sawyers Residential&Marine Construction,Inc./Ivan Sawyer
(Name of person or company acting as agent)
To act as my agent for the purpose of obtaining any needed Coastal Area
Management Act and/or Dredge and Fill Act permit, that may be needed for the
proposed development at the above indicated property,which entails:
To replace concrete boat ramp,jetties and install new concrete loading dock.
(Describe proposed development for which permits are being sought)
This agency is limited to the specific activities described above, and will expire
on: 12/1/2020
to on which authorization expires)
( ature) / (Date)
-Tri2.12Y . Cftgso,j
5 op,MFP-Fi&c. , Co14ituN17Y Prz0siDE(QT"
(Printed name of owner) Aso,. (Tide,if officer of corp.owner ortrustcc for propcny)
b
� r
} 1$

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Summ0(2-FJ64 cs Commiinisry
I hereby certify that I own property adjacent to loc.< 's
(Name of Property Owner)
property located at PAR.Gat- S153) 160 4-T RAIL4P Sum MFR-Ff 40 126
(Lot,Block,Road,ect.)
on Il i41:-Mi4R-L ScuNJ ,in i.JASitingo'roA) CoUN7t(
(Waterbody) (Town and/or County)
The applicant has described to me, as shown below, the development
proposed at the above location. I understand that any construction,excluding
bulkheads,must be set back a minimum distance of fifteen feet(15') from my
area of 'parian access unless waived by me.
r I have
a e no objection to the project as proposed but do not wish to waive
the(15') setback requirement.
I have no objection to the project as proposed and do wish to waive the
(15') setback requirement.
I object to the project as proposed.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development.)
Replace concrete Boat ramp,Jetties,and install concrete loading dock.
-Pri A-A-WA 1- &c. glgekdr_A_ _______e___CAIV._
Print or Type name Signature
01.S-a -'1 Vr— D iG9 01 G - ao - . o
Telephone Number Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
goof -Jl coo-vim)fry •
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at Pft L S S3 of Si�n�c µ FI
(Lot,Block,Road,ect.)
on A143eski eLF 50(bQ ,inWRS1f/ntc,TOnI COVNT'(
(Waterbody) (Town and/or County)
The applicant has described to me,as shown below, the development
proposed at the above location. I understand that any construction,excluding
bulkheads,must be set back a minimum distance of fifteen feet(15') from my
area of riparian access unless waived by me.
I have no objection to the project as proposed but do not wish to waive
the(15')5' setback requirement.
'✓ I have no objection to the project as proposed and do wish to waive the
(15') setback requirement.
I object to the project as proposed.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development.)
Replace concrete Boat ramp,Jetties,and install concrete loading dock.
Print or Type name Signature
- R-13c6 (o 721 Ao 2 C.
Telephone Number Date

NC Divrisicra of Coastal Mgt. Habitat Impact Completer Sheet
•
Applicant FvE2...0 ��M�+vi. �?
Date:? . , , 20-Za
General Permit#: --1,Le,D 5-g,
Describe below the HABITAT disturbances for the application. All values should match tie Larne,and units of measurement
found in your Habitat code sheet
j TOTAL Sq. Ft. FINAL Sq. Ft. j TOTAL Feet FINAL Feet
(Applied for. I (Anticipatedfirtal j (Applied for. I (Anticipated final
DISTURB TYPE ! Disturbance total disturbance. Disturbance i disturbance.
Habitat Name Choose One ncludes any Excludes ?ry total includes j Excludes any
anticipated restoration any anticipated ! restoration andlor
restoration or ' and/or ern p restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
i I I
S�AtLDr✓ i Dredge 0 FiII>k Both 0 Other
Dredge 0 Fill 0 Both ❑ Other
Dredge 0 Fill 0 Both 0 Other ❑ _
l?T�
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