55856D - Liles

MA / El DREDGE &FILL
NEPAL PERMIT
Previous permit #
w ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
by the State of North Carolina, Department of Environment and Natural Resources
rtName
al Resources Commission in an area of environmental concern pursuant
to I SA NCAC
D L Sv i✓ L- L �S
u es attached.
Project Location: County S �✓ c /�
Street Address/ State Road/ Lot #(s) 3/ 7f�2E
.r State/C ZIP 2 7; S
Fax # O
Subdivision
zed Agent l fi/Irl,� ,� �D�✓p^'
city�r!'0.9.- '—'Y' �P9'rh ZIP 2�f
❑ Cw E M ❑}PTA IDS ❑ PTS
Phone # ( ) River Basin 41-7
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
1
Adj. Wtr. Body r-,Ot !/�T /%✓�✓ (na�
❑ PWS: ❑ FC:
yes /Qn"o- PNA ye n Crit.Hab. yes / no
Closest Maj. Wtr. Body
bf Project/ Activity X OP Z g c P C_ X ' S 4, P 2 y
(Scale:
Jock) length ( P
;- T—lam—i
Bulldozing n
Z� Ve
ne Length [!
t I
not sure yes
gs: not sure yes __ ......... — �_ _ +
:rium: n/a yes o n l
' yes
Attached: yes no ling permit may be required by: iv �SLto c /f/ See note on back regarding
❑,River Basin i

AMM
NCDENR
North CarnGna Department of Environment and Natural Resources.
Division of Coastal Management
*ael F. Eas*. Governor James H. Gregwa, DkecW WV= G. Russ Jr.,
Authorized Agent Consent Agreement
�� !� n r�his h 1 eby autho d t act an my be
lPr 4vdNameolAgwQ
der'to obtain any CAMA permit(s) required for the property listed below -The authorization is limited i
xiic actmffes described in the attached sketch.
CATION OF PROJECT:
t _ .
c)►� C_
EPERTY° OWNER MAILING ADI)RESS_-
1;0k - 4L
Wf-k�_ rn Mc- 19351-
`PHONE NO. ' I ® n�%7 (0 - ' 3 J 5
HORMED AGENT•MAIUNG ADU(RESS:
PHONE NO. l'� y
- r _
of Pro�V nw-. A,-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIE1UMOORXJyG PILINGSBOATLIFT/BOAT HOUSE)
I hereby certify that I own property adjacent to N.d 5LNa I L.:,A eS _ 's
j (Nacre of Property Owner)
property located at
(Lot, Block, Road, etc.)
on CQglj QQ'- WAefici.in Lr pay'1 N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 91t, •,X'7,Mailing Address: �b 3c,y-, q O 1
1�vr"110Vrat
He has described to me, as shown below, the developrrent 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 (I Y) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
�zi
do not wish to waive
do wish to waive that setback requirement.
DESCRIPTION ANIXOR DRAWING Or PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developncent)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) 33 fb.
2n):&Y,
Mailing Address Signature
L'aU1.n i�f 1 _ 1�.11 � �_ J

ADJACENT RIPARIAN PROPERTY OWNER. STATEMENT
(r,ORA PIER/MOORiNGPILl"N'GSBOATLIFTIBOAIWOUSE)
I hereby certify that I own property adjacent to 1,50 ? L i I e5 I
(Narne of Property Owner)
property located at31
�Q
(Lot, Block, Road, etc.)
on CmAl aff��c2e QCe A,1r1 ��le� a c . _ N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:9 ► D,,2� l - 3 5 5-1 - Mailing Address: ?0 BuAAUL
Lnor;nhura MC —
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
1/I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fillet! in by individual proposing development)
(Information for Property Owner Applying
for permit)
0 22px_--4()-1- _
Mailing Address
Lcw,^,g q-
(Riparian Property Owner Information)
Signature
i c t f �� d 4J r �.•.So �t/

a
�aJ
f.x cJ�
I
a
of a6 -9c -9
;ws
7a M a 1:
t� C
wld-

i
-per
-- �
�.nQ� � �

icant: %y t L, f Ur/ L / L of
V911 .
Permit #: �— 7
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
Itat 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/o
temp impact
amount)
J
Dredge ❑ Fill ❑ Both ❑ Other
YX
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 ❑

ANTIC MARINE CONSTRUCTION
P O Box 713
Shallotte, NC 28459
Ph 910-754-4247
W
1639
66-112/531
o® $Aele
DOLLARS
Oe�eil5 on
Beck
BRANCH BANKING AND TRUST COMPANY (�
1-M-BANK BBT BBT.com
111000 63 �: 5 3 LO 1 L 2 11:000 5 29 50008 311' _