55881D - Lewis

�CAMA j DREDGE & FILL ��•
'ENERAL PERMIT Previous permit# NIq
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources
.oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
_ DQ Rules attached.
t Name Le w t is Project Location: County G(s lcw
Street Address/ State Road/ Lot #(s)
2 q State R6 ZIP
'l 1 d Fax # ( ) Subdivision Old1+I�-
Agent I �jf�Q City �, 'V ZIP z—
ed 1
CW WEW PTA XEs ❑ Prs Phone # 8L) River Basin tawe
t
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body M Oa- V r
- PWS: ❑ FC:
yes /,!no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body rm
' PrL}oject/ Activity AV6(4f k1L % t; (L LO SI t1 I I )S4 (1 iUL AA-1,I 41s C W S I y1;7T 1OL-l<
AA bc-�+� cyst, (Scale: { i/
:k) length
_.
Ax
ngth
nber
i/ Riprap length
distance offshore
x distance offshore
cannel ' 4 /X uU )(
)ic yards
1P —+
s/ Boatlift U. jtI z-- _
Aldozing
L_
Length '
not sure yes
not /suurre yes��n�o
um: Cn/a no
es I
ktached: yes no ' c
ig permit may be required by: Jt�Y
Special Conditions q4-1-56ji W

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATP
HOUSE)
I hereby certify that I own property adjacent to ���^ 4Pw 's
(Name of Property Owner)
property located at
(,ot, Block, mod, etc-)
on 61 !i C I , in C I N.C.
(Waterbody) (Town and/or Cou l )
Applicant's phone #: Q �' >�I l /� � l� Mailing Address: I G Le
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 Add
(Riparian Property Owner Information)
Signature

Id--q- ((

���
HCDEHR
North Carolina Department of Environment and Natural Resournes
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date q- �) -10
Name of Property Owner Applying for Permit:
), 6 4el— .' 5
Mailing Address:
r(e7 V
I certify that I have authorized (agent) b!{l, I rr-A 6 r, k�_ to act on my
behalf, for the purpose of applying for and obtaining alll CAMA Permits necessary to
install or construct (activity) rl a 4 h f l �(
at (my property located at)
This certification is valid thru (date)-_�
9-02/-/6
Property Owner Signature
Date

Division of Coastal Mgt. Habitat Impact Computer Sheet
flicant: Lew1s jai Permit #
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
)itat Name
DISTURB TYPE
Choose One
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
anticipated
restoration
any anticipated
restoration and/c
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount
temp impacts
amount
Dredge Fill ❑ Both ❑ Other ❑
2 0
?1SID
LA
Dredge ❑ Fill Both ❑ Other ❑
Cb
96b
Dredge ❑ Fill ❑ Both ❑ Other
COMPLETE•N COMPLETE THIS SECTIONON DELIVERY
■ Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired. ❑ Agent
■ Print your name and address on the reverse X CC/i?Q2_ - ❑ Addressee
so that we can return the card to you. B. Received by (Prin ed Name) Gate of Delive
■ Attach this card to the back of the mailpiece, Y
or on the front if space permits. $ S 1
D. Is deliv resf item 1? ❑Yes
1. Article Addressed to: If YETer delidd s low: ❑ No
' —' an
Pill,
� J
d
/> ` 3. Service Type
7 ❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
` (J/ ❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(?iansfer from service iabel) 7009 2820 0002 7559 4099
PS Form 3811, February 2064 _ Domestic Return Receipt 1o2,05-02-M-154o ;
Dredge ❑ Fill ❑ Both ❑ Other ❑
) 4 y 26 = 2 S?D

B AND B MARINE CONSTRUCTION
1168 WILLIAMS ON NC 27892
PAY
TO THE
ORDER�F%/�fOF
— 1 r 11.4 '
�e �WACHoyrA
dMsfon of WNb Fm"' Bsnk, N.A.
1034
6fi21/j3o
DATE
BRANCH 77W9
— � `�
DOLLARS LI o7 dY o
e �e
FOR
001034112 ':053
000 2 191: 20000 5
4 4 4 a 7 0 0 n, -- —-----