54559D - Kasprowicz

I-CAMA / ❑DREDGE & FILL 5i
!ENERAL PERMIT Previous permit #
fNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources ";?� ' f,�G�
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1
/ y _ ❑Rules attached.
t Name Me— wj / de 7t ?. fit'' J�Vl! "�► Project Location: County
sV/�/�
_ _ State ZIP
` ()
Fax # ()
:ed Agent
_'
/ 0- s-r �
❑ CW
/�'Y"/'i
/
4EW PTA / ES ❑ PTS
L�
❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑FC:
Dyes / no
PNA yes / nog; Crit.Hab. yes / no
f Project/ Activity
l-�-Gr � rlTie
>ck) length
ength
ember
adl Riprap length_
ig distance offshore r
iax distance offshore Z
:hannel
jbic yards
Lmp
'use/ Boatlift
Bulldozing
'ne Length _
not sure yes
igs: not sure yes
Drium: n/a yes
yes
r Attached: yes
Street Address/ State Road/ Lot #(s)
Subdivision Gr-1
CityZIP
Phone # ( ) S G*-+issue River Basin e- l
Adj. Wtr. Body /. 4o f,,e5 � � � (nat IZ,
Closest Maj. Wtr. Body
(Scale: l
ding permit maybe required by: 4t/Gi!'V 111"Z YP.d �� - HSt1. U See note on back regarding River Basin

AM ��
,
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 AP✓ �L 3'� Z o! o
Name of Property Owner Applying for Permit:
Mailing Address:
4/7 Pp S Nam;
I certify that I have authorized (agent) 0!�O-Qto act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) New
at (my property located at)
This certification is valid thru (date) 4`tg'-a3 ) , Zo ! O

All

uk) -'u VV.ZUG l;ij0 ? "') dan
y1'.a. - 46/ - f=5 P.-"
:����,�c.��:n 1' 1"Y,4,laMAtV
I hereby ctttixp that 1 own proPesrty adjacent to
(Nnarr of Pt+o .s
Perk' Owaer)
nraperty located a,
( Lot, Die* Rand, ete.)
a�n
ow�a �mdlor f , N.C.
auaty)
-Appikant's phone #: Mailieg Address:
Ike -bW drs:cibtci to JI]C, AS shown below, the develOpmmt he is proposing at that +ocatiott, and, I
have m objectiom to his Proposal,
DESCRIPTION AND/OR DRAWING OF FROPMEDpEyP;L4PMENY;- .__�_
Idled art by Properly owxer proAwsing.feve&gmWW)
------ ---------------- --...... --........ --------------------- -------------- -
(Infon na*n far Property Owner Applying (Ripurint Property Owner tnronimation)
for Perm itt
Mailing AddW51
17
Print or Type IN ame

ADJ4.C:ENT RWAR.IAN PROPERTY OWNER STATEMEM'
l hereby certify that I own property adjacent to
property located at
(Name of Property Owner)
(Lot, Bloch, Road, etc.)
oil _ in
Applicant's phone #:_
{Town and!or County)
"Mailing Address:__ _____
H4 has descriExd to tne, as s_wwn heiow, the developmeri he is proposing at chat location, and, I
have no objections to his proposal.
DI;SCRI `I'10N AND/OR DRAWING OF PROPOSED DEVELOPMENI':
(To be fdlleed in by property owner proposing development)
(Information for Property Owner Applying (Riparian Property 0%ner Information)
for Permit)
�-
Mailing Address � Signature
C.�`77vT �'+�'� r �"i r�l �Lr'CJ �`t'�. � ��.�rti.LS ! l� ✓l.�J__.
C'ity'state/' 2 f!�Y/ Print r Type Name

C Division of Coastal N19t. Habitat Impact Computer Sheet
Dplicant: �ad ��� 4445po'��`�' Permit #: S
ate: (7—
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
fund in your Habitat code sheet.
abitat 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�f Both ❑ Other ❑
aU
46
Dredge ❑ Fill ?I Both ❑ Other ❑
2d�
Zc��
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 ❑

B & B MARINE CONSTRUCTION
PH. 910-540-5135
W45 9TH STREET
SURF CITY, NC 28445
int Federal
F), NCi728443 `
Date
11900 104 211' 0 253 27 1945l:580600703611'
1042
67-7194/2532
s yVd,eo
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