55857D - Beaver

LAMA / ❑' DREDGE & FILL �-
PERMIT Previous permit #
�F�ERAL
[-]Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
ii :zed b;the State of North Carolina, Department of Environment and Natural Resources
coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC /Z/•
& RMes attached.
it Name R 6'4A e -9 v Project Location: County 1?,a a a1-c. • C /l
yy61 �'UIE� y && DEC . Street Address/ State Road/ Lot #(s) .2J' /Cc-L
vv—a ' State ZIP 2 %6/ T�K zC Lr, S4
(7Q) y3/2 Fax # ( ) Subdivision
ted Agent City EU L Vf ZIP-2�
❑ CW 11-� L1PTA C-jfS ❑ PTS Phone # ( ) River Basin 44419
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
Adj. Wtr. Body l GCAWOa.oD /24 (v n
❑ PWS: ❑ FC:
Closest
Maj. Wtr. Bodyyes /moPNA yes o. Crit.Hab. yes / no�
f
0
1P
bic yards
'n - -
is Boatlift �Z �� i! (/
y
lulidozing
61
ie Length 12 % qJT
kf fl
not sure yes '
:s: not sure yes �)
-ium: n/a yes
es no
O �t
Attached: yes �.-.___. __-- —_ _._ _
ing permit may be required by: �`( l�q/f c✓i <"e f�cu,. i �„ ❑ See note on back regarding River Basin r
c—;e i r—A*.«'.— 'q r.? ri, 7 r lU n ie t...., , _ L ><_. -L

V. 1 10,010
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFTBOATHOLSE)
I hereby certify that I own property adjacent to Z 94W T)•
(Name of Property Owner)
r
property located at (( 2 J
(Lot, glock, Road, etc.)
on �, inU% �(� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:,454- 4 5 ( Z Mailing Address: A4� ( /
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 (IS') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
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)
(Riparian Property Owner Information)
Mailing Address
/,o -- I r n
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at Z 6 j 7
2VI(x �e42ez!e —
(Lot, Block, Road, etc.)
on 1. ��ItCkSyccp t7� l , iny I (71 dJ- , N.C.
(Waterbody) f (Town and/or County)
Applicant's phone #: eaq - 5 Mailing Address: `T j 5at>-C vJ A`
a-L F Aic . z Se?r<;,(
He has described to me, as shown below, the development he is proposing at that location, ard, 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)
5-12- (1) �, �4-
-ZC-1 (.-
(Information for Property Owner Applying
for Permit)
Mailing Address
iI %,
(Riparian Property Owner I
�t -
7&zWd"_ �A
6LCI

)licant: • Gr/� ei`��`l elt Permit #: 5 S r.5— 7— D/
e:
2 -2/1v
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremenl
nd 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)
(A/
Dredge ❑ Fill ❑ Both ❑ Other
�
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4j egIZ5%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 ❑

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MARTI FOWLER W-7143/2531 1625
LIC. 8989009 OMOI17430
4461 SWEET BAY PH. 910-454-4512 �
SOUTHPORT, NC 28461 DATE i
DOLLARS
ow.uM.o.
,fml v6, cfc% e,
Southport,
1: 2 5 3 I? L 4 3 0 ,: � ` FT----- -
0000 L L 7 4 301i' L 6 2 5