54454D - Cranfill

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
Drized by the State of North Carolina, Department of Environment and Natural Resources —
Coastal Resources Commission in an area of environmental qo ern pursuant to 15A NCAC f/
71 Rules attached.
nt Name A
Project Location: County
s Q• �d !� ©�y Street Address/ State Road/ Lot #(s) 4/
L `° MGNf State ZIP 2 %/ )T � . SG✓
zed Agent
❑ CW ErEW C1 PTA [ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Subdivision
City 5X9 1 i o
Y'-
ZIP Z Ay
Phone # () River Basin L
Adj. Wtr. Body /
yes /cna PNA yes / ho Crit.Hab. yes / no Closest Mal. Wtr. Body
if Project/ Activity �•Js �¢ %1 /(' �� - %� 9� 6,i"fi i �� �A c✓ D L X ' S �' - J Z7yf 0' O P'Oe
0
(Scale:/
ock)leneth
pier(s)
ength
umber
i
ad/lap length IJ 40
ig distance offshore
iax distance offshore / Q /
:hannel
ibic yards
mp
use/ Boatlift
3ulldozing
ie Length V
not sure yes
gs: not sure yes
rium: n/a yes (�
yes 4w
Attached: yes
ing permit maybe required by: 302 b 'S"V "r)e 4r6N ^' T y ❑ See note on back regarding River Basin r
A, . I / /- . . ' — -

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to rorre�,+ t" .CrAIN i I .`/ 's
(� (Name of Property
d� ;
Owner)
property located at YC�U'C� %� q 33 vat'
�— �/�
1 ^^ (Lot, Block, Road, etc.) ff
on (\�rC.J4't i�a \ lJ�.� lA.(v , in r� �� t.V.C,IC �(.?��� , N.C.
(Waterbody) (Town and/or County) v
Applicant's phone 1/:39s=0966 Mailing Address: �`jtC g30
;gyp nnu- -�) A VC 1
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)
S Pe � clt.�,v, •
---------------------------------------------------------
(Information for Property Owner Applying
for Permit)
T'-) o Q� ox so,�-
Mailing Address
C\P-� �Y\u 17 C)
------------------------------ ---------------------------
(Riparian Property Owner Information)
Stgnatur
7, k�� ti A,0(3, - G AV-,

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I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ('ae't t, Crain 3, `/ 's. .
(Name of Property Owner) p / /
1V� 31, Val II+Cx W
property located at I i C�tC2 "1 rC !� .29170
(Lot, Block, Road, etc.) /1
on (L r '�a , in2>C05UJLn`y_t_,r_`� �, N.C.
(Waterbody) (Town and/or County)
Applicant's phone !#: 6 3yS0966 Mailing Address: 0 � �(
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)
'P0Q -ee �-
Mailing Address
. &—� �Y\u
(Riparian Property Owner Information)
Ef Wr, !�
A 704�:I_

Division of Coastal Mgt, Habitat Impact Computer Sheet
)licant: `p rC /C -eS
te: 3/L
�'- yu�-y-)
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat 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/o
temp impact
amount)
Dredge ❑ FillP,Both ❑ Other ❑
/� Q
d
/ / a71
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 0 Both ❑ Other ❑

FORREST C. CRANFILL CONSTRUCTION
P.O. BOX 805
CLEMMONS, NC 27012-0805
it PAY TO THE
ORDER
66-1209-531 2854
DATE
-----�� $ �� "C! ai✓
Southern DOLLARS 1J `tea'
Commune
BA�'K A�S.�,/
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