53973D - Oberg

XCAMA / DREDGE & FILL
ENERAL PERMIT
Previous permit#
I 'New Modif'cation Complete Reissue
Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
_
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
ules attached.
nt Name 6 ( AVT';' jz-1 - I Q&-AZC,
Project Location: County_
ss i '_;ti } 1 TV-, I-D�lZOL.� 03LA, (Z'O
. Street Address/ State Road/ Lot #(s)
1�NY4AJ, TyNa-Q - State NL zip
_
P49 � L,�.
z
# (`I tl') i ci- (' 4t7 Fax # ( )
Subdivision L-91-- I ►`
•ized Agent r`Z2 t G SO l �- S,
City ZIP � N
❑ CW BW ❑� 1�TA ❑ ES CI PTS
�d
Phone # ( ) River Basin ❑
l: ❑ OEA ❑ HHF ❑ IH ❑ UBA 1 N/A
Ad . Wtr. Bod /� A �n
1 Y /VIX�L^ C1CZ�
❑PWS: ❑FC:
yes /0 PNA yes / Co Crit.Hab.
yes / no Closest Maj. Wtr. Body A I \&j Al
of Project/ Activity - ; - j If— 1 =
f-1=K L L FJ I - i�i,)+ l f tl, j„(1 i Ili Lr-1 I K
(Scale:
Jock) length= f l I (C I P 1
pier(s)
length
camber
aad/ Riprap length
wg distance offshore_
nax distance offshore
channel
:ubic yards
amp_
ruse/ Boatlift 1 y I t
Bulldozing
V LC Of ZC x r'
ine Length _? 10 0
r
notsure yes
igs: not sure yes t)
:)rium: n/a yes 0
yes C'7
Attached: ves iTio i
ling permit may be required by: �ri=�Z ❑ See note on back regarding River Basin
/ rz—;i l vl z , /9 in 1 Tl .l e 1 f r iG 7 Ll 1'7 .•1'l r n . , . - - _ -k ,. _�— A - n .

Division of Coastal Mgt. Habitat Impact Computer Shut
rA VT-
plicant:
�t 5:3w� 3
Ite: �-j LC/
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in vour Habitat code sheet.
I DISTURB TYPE
abitat Name Choose One
V11 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 ❑
Dredge ❑
Fill ❑ Both 0 Other ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
and/or temp
temp impacts
impact amount)
( O
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
Disturbance
disturbance.
total includes
Excludes any
any anticipated
restoration and/c
restoration or
temp impact
temp impacts)
amount
QAC

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S

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
jovernor Director
AGENT AUTHORIZATION FORM
Date: a I (P I Zpl U
ame of Property Owner Applying for Permit:
sm"► clv%d Tev k C' `�4
wner's Mailing Addr ss.
c. a
hone Number 9( lu) 31 q - 0341)
Dee Fre
Sec
Name of Authorized Agent for this project:
J�� Secs
Agent's Mailing Address:
Phone Number (Cis , ) ?_L .L - L J9
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity): 1
20AAfIAV.1 / nAA nvN tf1 �1A11 --� -, I ,,Ar. f��_ (I'A _�_ r !� A (,L
ny property located) at
his certification is valid thru (date)
I'7)�dL—d C)�-XACA,
Property Owner Signa�t re
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to fbra4 a_v,ci. Teri C 6 rg 's
(Name of Property Owner)
iroperty located at 1()3 li1'i t tL �4 eron Cove. W. d , ,
(Lot, ock, Roa , etc.)
in treeL OJ NA0. �a;nt , in A!MDS N.C.
(Waterbody) (Town and/or County)
applicant's phone #: q10 - 319 - 0340 Mailing Address: 103 Wh�� 14ew►) Cove k
t w.L),,- Ito. -A - 1Q d . P A441
le has described to me, as shown below, the development he is proposing at that location, and, I have
Lo objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Information for Property Owner/Applicant
Applying for permit)
103 L'3.k1.0 4emvl Cove Qd.
vlailing Address
_4w.4DI&�eaJ , t 1 C. 20443
'ity/State/Zip
(Riparian Property Owner Information)
a
Signature
I -R&CV
Prin?-orlfVDe Name

ADJACENT RIPARIAN pROFERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to s
(Nome of Property Owner)
)roperty located at 1 b-6 U.)K+." VAercwl av[- ZcL . '
(Lot, oclt, Ron , etc.)
3n e L aj OUL T6;MA0--, in , N.C.
(Waterbody) r (Town and/or County) 04
kpplicunt,$ phone N. 41b ~ -3 Kl - O'b4b__ Mailing Address: i C $ why _
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
S ec A Aa&�,ed skuo,,4 -
(Information for Property Owner/Applicant
Applying for permit)
103 i,,� WL6 W emyi eoyG
Mailing Address
Gity/83a�p � -
(Riparian Property Owner Information)
Signature
Print or Type Nama
c) a fd5-73 -0
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BRAN ► n. "-- _ ID
THERESA H• pBEPK pate Z�
602 GATU IG POINTE PK
SMIT'"ELD, VA 23�0-2302
PH. 1-757-361 /' S��
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to t_=---
Bankof America'
ACH RIT 0510000t 3�' `
Memo ►, 0OhL3�+6.�,.
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