55874D - Bruff

LAMA / 'X'DREDGE & FILL
i E N E RAL PERMIT Previous permit #
14ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ted by the State of North Carolina, Department of Environment and Natural Resources +'
:astal Resources Commission in anareaof environmental concern pursuant to I SA NCAC_ �N . � l u
�! byvlln 6Y'V4 JtyPetId{uK attached.
NameProject Location: County �
1'l.'n 1.4 . I 1 /I, I V _.
StateHQ, ZIP 7 U
4-41.'' Fax#( >
edAgent ) l�yluV�iif o��1S�N1/L�iC1.�
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes �/ no . PNA yes / no ' Crit.Hab. yes / no
Project/ Activity
lock) length
length
camber
,ad/ Riprap length�
:vg distance offshore
nax distance offshore_
channel
:ubic yards j 4
I 1
amp { —
)use/ Boatlift
Bulldozing-
I if NI A W5 -
a
ine Length
not sure yes no
:gs: not sur yes--
)rium: yes no
fy
n i� 7
Attached:no
Jing permit maquired byt'
Street Address/ State Road/ Lot #(s)
113 F �m/►& vk .
Subdivision
4city k a ZIP
Phone # (�:IIU ) Sqt- j{ 3 River Basin C 6(ak
Adj. Wtr. Body Oa A6L( (I
Closest Maj. Wtr. Body SUU11A
Mtn Ct
(Scale: I //
❑ See note on back regardingRiverBasin

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date q'
Name of Property Owner Applying for Permit:
- 1-4 a r\.0 % e/,/ I/ �*
Mailing Address:
�_
1. 9 <6101 -
I certify that I have authorized (agent) 1jeq1jZe ��� i� �� to act on my
behalf, for the purpose of applying for and obtainingallCAMA Permits necessary to
�
install or construct (activity) �4/ u� l /� h°� � � A L l f
at (my property located at) 3 13vY
J
This certification is valid thru (date)' I
Property Owner Signature I Date

�l �

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to d% ,tS &Uq"
's
(Name of Property Owner)
property located at 115 &�, k �z
O,ot, Block, Road, etc.
on 61912al , in Fiqwa/�iia , N.C.
(Waterbody),�// ,/ (Town and/or County) /�1� �^
Applicant's phone #910— 1771'��, 46 `l Mailing Address: d
(�t! c17u'-
'r��n
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Addres�s
Wjllr-ni�
City/State/(i
(Riparian Property Owner Information)
CAI /l
Signature
,Ek I) l 14 � - S67L E R--S
Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STAT MENT
I hereby certify that I own property adjacent to �� -s
�. (Name of Property Owner)
property located at
on
(Waterbody)
9bek Road,
in 1 /( r`� �iN.C.
(Town and/or County)
He has described to me, as shown below, the development he is proposing at that kyriililA. ad, I
have no objections to bis proposal_
-------------_----•.---___��
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be +f T W In by r u paq► *wee.,prWdvbg *vdWmm#
on
(1, Cm ttyllMa for Property Owner Appiyft
Mailing Addnm
City/Statrizip
910��� 3�(
Tekto Nul"b"
OU-
JU
1 it
r
la'a 5,* f7 Js
Print or Type Namc
Tclq*onc Number
C -- / / / - --, - / /n

I'M
LOW
AIM
Pitt
OP
or
zzz�

C Division of Coastal Mgt, Habitat Impact Computer Sheet
I
ite:
l
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet. F t FINAL Feet
labitat Name
DISTURB TYPE
Choose One
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other 0
TOTAL Sq. Ft.
(Applied for.
FINAL Sq. Ft.
(Anticipated final
TOTAL ee
(Applied for.
(Anticipated final
Disturbance total
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
includes any
anticipated
restoration
any anticipated
restoration and/or
temp impact
restoration or
temp Impacts
and/or temp
impact amount)
restoration or
temp impacts
amount
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BAND B
MARINE CONSTRUCTION
1168
WILLIAM COEYC
RDRIVE
STON, N27892
1030
PAY 66-21/530
To THE I
BAN778n
ORDER 0 DATE
4�111A C7
16 ...........
WACRO
W4. R Bank, a CuAtion of W8119V" Fargo Bank. N.A. (PFJ)
FOR /� p
Ila
0- 7Aprl (4'P
01030118 IN053
..... UUCJ 2 191: 20000 . ...... --
tua 700112 NP