55816D - Eves

-1 CAMA / !_' DREDGE & FILL
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GENERAL PERMIT
Previous permit #
y�New Modification ❑Complete Reissue C'Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources J f I
Resources Commission 15A NCAC-75�
Coastal in an area of environmental concern pursuant
to
nt Name l' S N -
((�� Rul s attached.
, Project Location: County iP � L c,+ ,
s qJC
Street Address/ State Road/ Lot #(s) W
ateNc ZIP Q�ggS
(l kld( c
#) Fax # ( )
Subdivision
ized Agent ��v)(1 t) C'�V1 Y>�
iJC.
City \ - , ZIP
❑ CW XW )(PTA )(ES ❑ PTS
/2��9
P net# ( ) 5 - 3� River Basin
d
❑ OEA ❑ HHF IH ❑ UBA [IN/A
J
Adj. Wtr. Body OW Cha B EU f (nat
❑ PWS: ❑ FC:
yes / no % PNA yes Crit.Hab. yes / no
Closest Maj. Wtr. Body l�il UV1G�
A Project/ Activity
lock) length
ni
pier(s)
length
umber
:ad/ Riprap length 4-zl
vg distance offshore
iax distance offshore_
channel
ubic yards
amp
)use/ Boatlift
Bulldozing
r� P Ar v
al
ine Length h
not sure yes no
igs: not sure yestno -} / "lzz
)rium: n/a yes no Vl- Y�I
yes Fn-
fing �11
Attached: yes permit may be required by: IVAI P� f>„d or .
-.I I I I If,K 6 I I ." I. . I
(Scale: I
"Am —hp ?"F6$t O%
,❑� 1; i"� t Ell �{ (�. �• � 11ri�A
t i f ks4
J CF
/ WCTLA ON
if vL-l�-1 I t:-x
❑ See note on back regarding River Basin
I i t

AgTolm
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 r- (� le
Name of Property Owner Applying for Permit:
Q I'1 PS � L l5
Mailing Address:
I certify that I have authorized (agent) PI-q �/-, S to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) bell k/,"acl
at (my property located at)
This certification is valid thru (date)
/"",- �r - le
Owner Signature
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to ) i m ty $ rV e$ is
(Name of Property Owner)
property located at n(61RIki l ,
(Lot, BlockQRoad, etc.)
(1
on . in tJ(�f 6k, N.C.
(Waterbody) (Town aA d/or County)
Applicant's phone #: q 1 122 390 � Mailing Address: '
uc �
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 (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)
(Information for Property Owner Applying
for Permit)
Mailing Address
n -.
1q
(Riparian Property Owner Information)
rzz
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to � r0fa &&6 is
(Name of Property Owner)
property located at _f"
on
(Waterbody)
i(
(Lot, Blo&, Road,
etc.)
in , JAP , N.C.
Applicant's phone #:110
(Town and/or County)
1
Mailing Address: 4 4I 1 �(UCc
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 (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)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit) _rf
it Kk &�,A fZ I JQc,
(Riparian Property Owner Information)
Mailing Address
r-- n n ,— . I A
Signature
b it-

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vmr"
7V
AWE
a
Ek

NC Division o-f Coastal Mgt. Habitat Impact Computer Sheet C
Applicant: eve S
Date:
J/IMP/l0
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet. TOTAL Feet FINAL Feet
Habitat Name
DISTURB TYPE
Choose One
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other
Dredge ❑ Fil Both ❑ Oth r
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 ❑
TOTAL Sq. Ft.
for.
FINAL Sq. Ft•
(Anticipated final
lied for.
(Applied
(Anticipated fim
(Applied
Disturbance total
disturbance.
Disturbance
total includes
disturbance.
Excludes any
includes any
Excludes any
any anticipated
restoration and,
anticipated
restoration or
restoration
and/or temp
restoration or
temp impact
temp impacts
im amount)
temp impacts
amount
— l z.
)acct
`— z

B AND B MARINE CONSTRUCTION
1168 COREY DRIVE
WILLIAMSTON, NC 27892
PAY
TO THE
ORDER OF_
r
® WACHovrA
Wac-Wa Bank aaWion
�2 0 (le"ly
1009
W21/530
BRANCH 776n
DATE ` _
of Web Fargo Bark N.A.
FOR �'P 5S81 •
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n■ 0 100 91I■ ':0 5 3000 2 191: 20000 5 44 7001I4----- -
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