54438D - Epps

�CAMA / ❑ DREDGE & FILL'"
3ENERAL PERMIT Previous permit#
New Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources l'
�oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
CIRales attached.
it Name Y C nOf Project Location: County -.*, / C /C
O GAGs,6
d
Street Address/ State Road/ Lot # s
of Tom State "V C ZIP 1 ?'z/ f -
E( )S 7V-09YZFax#( )
:ed Agent C�gA e.-f /;72Fi/L _
❑ CW [qEW 0 PTA L4ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Subdivision
City tQC P H 1 7,S L P ZIP.
Phone # ( ) River Basin I L""i ,
Adj. Wtr. BodlJ />4/ei/ 6,1 (nat S
yes /fno / f% Crit.Hab. yes / no
Closest Mai. Wtr. Body �y G-V e-,/
PNA ye
F Project/ Activity & P d cw c e S/ Z D C �J� ' S f, ,.� t a A �Gc o/c/ /A//
(Scale:
,ck) length r K . 54, e
i
!ngth
amber
d/ Riprap length
g distance offshore
ax distance offshore
hannel
bic yards
np
t 4
ise oatli
,ulldozing
_v
e Length S U
not sure yes
s: not sure yes
•ium: n/a yes CDo.
Y- y
Attached: 4Z (:C--- no
i
ng permit may be required by: 61C.0'4' . j!?P9L ❑ See note on back regarding River Basin ri
- . — .... rr.. _ _-..-., so ..,, — .._i ._ _ / . ,1_. /n '_ l )/ /.

7 uolasiaoro J-t,
❑IB
Dposed Lift
10'-
0'-4Y4
9'-53/6'

,tDJFaEN P�A4100 tl!YG FILINUSSMO N PROPERTY�LI TIMOTNOUSNER NF�;►2T
�trll�
I berehy certify fkat I OKn Property tdjaeent t<.Guam Owner;
int+,cst, iocated a:
(1.0t, Block. Road, eta)
an (Csvm and/or GD101Y) ---
tWaterbcd7)
f. Mailing Addecss:�!S ! e r {
Arplicant's Phone R
iie has drscribad to one, as shown bcMw. Or QevoWl,rrmt he is pmoposinp at that location, and, I
boathouse
have no objections to bis Pr°PO— I unicrstand that a picrimoming pilings t b.^.at'tift I
mats be svt back a nxnimtan distutceof l,":kcn :emt (I 51 from my 'ma of riparian access uniess
waived by M. ¢f YM ritsE to "ran'e the setback. }au ruus✓ t�n!dal tbe appropriate btaek
bolo+Y.T
3p� not WM to waive
{ ,,, wish to waive'ltat set!xdt tequirrmena.
DFSC1tIPT (To & pied it by imrmdu prvpo n DRAWING OfF � pmve"6 PMEiv:7:
i
� i
(Inforaoation for r-PeM Owner APPIY�06
for Permit)
htaiting Addtcta
Can•Istat `T lc/i� .__�
lephene
_...__
S If,'C.aLW4' Our
(RiparianYrcperty 4wner Iwfonnztion)
S,g
tour
�� tc-4c
�' mint os Type'.Vamet
,cicph,jnc'lumber
[?a'e

{,'Alb au.? VVI-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORWG HUNGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to J s
(Nam f Pro ty Owner)
property located at
1 (Lot, Block, Road, etc.)
on C in R . N.C.
(Waterbody) (T(nn and/or County)
-� 7 CIS AkLi � Gf
Applicant's phone #: y Mailing Address:
Ya-t 77�i.15
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 piertmooring pilings / boatlift / boathouse
must be set back a minimum distance of fifbm feet (151 from my area of riparian access unless
waived by me. (if you wish to waive the setback, you mnst initial the appropriate blank
below.)
I do not wish to waive
142 wish to waive that setback requiremenL
DESCRIPTION AND/OR DRAWING Or PROPOSED DEVELOPMENT:
(To be filled [it by individual proposing devdoppnenf)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) .-n h -.4--
,/S C f
Mailing Address
City/State tp
�..,
M f �i c L
elephone Njimb.er
9Z10
Signature Date
Signature
6 6 00 Co fir
Print or Type Na
-7a 36 1 q 39
Telephone N mber
/—ZS-Zv�v
Dare

12 09:08a Charles Maree 910-842-4049 p.2
. .dAm,
CDR
North Carolina Department of Environment and Natural Resources
division of Coastal Manamment
Severly Eaves Perdue J&nes H. Gmgson
Governor Directo-
AGENT AUTH©RgA' ION FOkM
Name of Property Ovvn®r Applying for Permit
Mailing Address-
.Burr` i{%ci
Phone Number:
Dee Freeman
Secretary
l certify that t have aufrized (agent) 6" at e, 1� to act on my
behalf, 'for the purpose of app;png ic, and cbtaiiniag��alll LAMA Permits necessary to install or
construct (activity) �%IE4 .xEx�kz bw.� IA::
at (:ny }property located at)
This certification is valid thm (date) 41
r L2f k
Property ChNmr Sigaure
127 iz i]dveEzt., iRiuNeglca, NC ZSG5
tie,. 9ta796.72M; FV' 910.395.3964 net
a.f*XOWtA *1tA&-.Q6WrG6wfm{dc�e
©ate
NIbr`thCw olina

02 09:10a Charles Maree 910-842-4049 p.2
WDFWR
North: Carolina Department of Environment and Natural Resoumes
pivlh�wn of Coastal Managemed
Beverly Eaves Perdue .lames H. Gregsor.
Governor Director
AGENT AUTHORIZATION FQkM
Date:
Name of Property Owner Appiying for Permit:
Jl
UW Aing Address.
f A �-
I�c��%h c�it. ti/G Z7,6
Dee i=reemar,
Secretary
I certify that I have ouborized (agent) 4tr �Qf: , : _ to act an Tny
behalf, for the purpose of appiying for and obtaining .all LAMA PerrnAs necessary to instali or
construct (activity) & 4 -_- b& ak I - - - -
at (.Try property iocated at)
This cetiffcatiort 1s valid thru tdate) d!
property Owner Si re
Date
t
1TIG2rt�natt iue'cxt, iFCR 91 t RiC<8406 -.46 n&l�i rsh f-+-oliina
Na
Phoae:9! C 795721`, l FAt 5?!}395-3564 Irr�raet' vrv+x,roCOasWt�TunaBc"-nn`LneF 81Y
�. fs�oxOGf�'aS4tAR�raGw Fe7imFm..

-ion of ConOnl Mat. Hnhitat t ComputerSi-,
cant: S/�� / Cs Permit #: S Ll
31 6/�D
ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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/c
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
2 U
12 G'
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 ❑

WATERWAY CREATIONS LLC
405 STONE CHIMNEY RD SW BS. 910-619-0655
SUPPLY, NC 28462-2662
F
BRANCH wo-sA aAND TMT COMPANY n \
� 8 0 ♦ 1-BOo-gANC BBT gBT.com
For `c2L2/i/l%4 `l�xTf"tc�
1441
W11?/531
Z- C�
mile
$ -;10 e
Dollars
Mp
17J�`
is05310112Li:000529429375tlIIv0 0,4L