56508D - Garrick

CAMA / 'DREDGE & FILL
,3hENERAL PERMIT Previous permit #
New Modification [-]Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources A- ,
Resources Commission in an area of environmental concern pursuant to 15A NCAC 2//, / / &
[!T%Ies attached.
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it Name -lx i e,, K, c le, Project Location: County 2?1Z 4"'y rW1 C,/(
7, Street Address/ State Road/ Lot #(s)*19
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state zip 2 >l c'
Fax #
:ed Agent
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COEA
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El FC:
yes / no
PNA yes / -nciiw— -Crit.Hab. yes / no
Subdivision
City zip 2 � VA
Phone# River Basin
Adj. Wtr. Body
Closest Maj. Wtr. Body A/
' Project/ Activity % .4 C ,e , L)e' 1 11, - * Z , , -;, &4, «� W 0�
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ig permit maybe required by: S&fC4 El See note on back regarding River Basin

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North Carolina Department of Environment and Natural Resources
Dyision of Coastal Managnment
Beverly Eaves Perdue James H. Gregg
GDvernor Drectrir
AGENT AVTHQRIZATION FORM
Date: mhs//V
I f
NaMp of Property Owner Applying for Permit,
T—
Mailing Address:
24,') 1
Phone Number:
Cgee Preen
Secret
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to install or
construct (activity)
at (my property laic
This certftation is valid thru (date)

12 10 08;20a
P. 1
ADJACENT RIPARMIN PROPERTY OWNER STATEMENT
I hervby cmify that I oven property adjacent to a (48, Inr P ro pirty Own* r)
pmpct[mated "AL
—ZaoWs— 1
aterbody) wn =dkr County)
-k+°
Applicant's phone 7 "-271 M;ii1fiigAddrevxj�
, ( %I Z10
tic has deuribed to M as shiDwn below, the davel opment he i% proposing at that location, and, I
I rift, -It no Objections to his proposs).
DUCRIMON ANVOR DRAWING OF ]PROMSED I)MLOPMEXP�
(To befilkd hi byprop" owwpeop. osiefg deW1vpo"&4
�4 'TF
L)
00ormation for Property Owner Applying (Riparian PropeM Own -or Istormation)
for Permit)
Malting Addms,
city/StAcizip
Atury
Print or Type Nwne

;t 12 10 08,-?Im P'2
A DJACCNT RIPARMN PROURTY OWNER STATEMENT
I bm* catify that I own property 4mcat to
{Nm (Proptity Owner)
ljm,
pfGper-ty located at
(Dot, fliock, ROO, etc.)
on in r-HN.C.
(W*ttrbody) (Town and/or County)
'Apph"nt'i phnoe Mailing Address: f
lit has 4ewibed to mx, as shovom below. the dew-lopment be is propceing at ihat kwAikm, ArA I
have no ob*lions, u) his pTopn&al,
DESCRUTION AND/Olk DRAWING OF'PROPaSED BE VELOPMM:
(To befW*4 In 4 prop",owner propwing develppmmm)
>lctsfv!� Doc.-&
Ito f CIV*V I r%A
(Information for Property Owner 4plying (Riparian OWSWA *80m)
for Permit)
A 4(tU6 �'
Mai Ad&css ignature
CL
city/s�
Aelmola havl
Prim or Type Name
6-, 10//-7 .019n4Q

Division of Coastal Mgt, Habitat impact Computer Sheet
Permit #: �✓�s -�
ie:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
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)_temp
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
impacts
FINAL Feet
(Anticipated fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
st
Dredge ❑ Fill % Both ❑ Other ❑
J lJ
SD
j�
Dredge ❑ FilIA Both ❑ Other ❑
/1 OCR
� �/Q�
Dredge ❑ Fill ❑ Both ❑ Other
�l �G '
G ' G't
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 ❑

Beene Construction
P.O. Box 370
Supply, NC 28462
DATE
BRANCH BANKING AND TRUST COMPANY
1-800-BANK 68T BBT.com
G9 �05(6 C�2J i
"'0000 1008"m 1:0 5 3 10 L L 2 11:000 5 LO 4 2 L 3 3 18ji'
1008
66-112/531