54592D - Pike

CAMA / DREDGE & FILL
iENERAL PERMIT Previous permit#
New Modification Complete Reissue Partial Reissue Date previous permit issued
Ozed 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
�^` 1A Tiles attached.
it Name - /C�,,y T/ L G. Project Location: County &Eq' Sel. /[
1 -'r r'O L 41 S C O c.ir Street Address/ State Road/ Lot #(s) %%,2 % 5Cy
fQq�,, StateNC
k (1�) 7 f %-27" Fax # ( )
ted Agent /? )C ev I)- ewe/
❑ CW 13i-m [;PTA DES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / no PNA yes / fro) Crit.Hab. yes / no
60 J,-j 'e .,
Subdivision
City_ JaZdo, QDAcZIP-Z"
Phone # () f River Basin L4/i2
Adj. Wtr. Boc!Y-O- ✓ l 01�{ /�/i% (nat
Closest Maj. Wtr. Body 1414.1
Project/ Activity fdZ I V jtJ:7 C , r .L j 1i'G
k) length (Scale:
s),L x16 i
pier(s)_
length _
number _
ead/ Riprap length
ivg distance offshore
nax distance offshore
channel
:ubic yards
amp
ruse/ Boatlift
Bulldozing
ine Length �] Q
not sure yes no
igs: not sure yes
>rium: n/a yes
yes 5
Attached: Yes t no
ling permit may be required by: AM n,✓
lePf%C
J
❑ See note on back regarding River Basin
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Govemor James H. Gregson, Director Dee Freeman, Secretary
Date C. / V
Name of Property Owner Applying for Permit:
k i Q cxn AM
f
Mailing Address:
flak Caic.'s co".�- t
I certify that I have authorized. (agent) K % Ckv I t e c — to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) cA c oc k
at (my property located at) t a7 SC-0 In ganyxei . 4WAe-' (3 "C'1, rAIC.
This certification is valid thru (date) 1,:- 16 0 1

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AIJIM11 Of Ill L11 MA'AM 'AfMOf Xlhl I M" 12
INAIAM \ 1% W`IkMO A IMAMINJ %\ DRAIN 1 %&)VMV

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIERIMOORING Pff &GSID0.4 UlFrISOATHOUSE)
I hereby certify that I own property adjacent to `,k; u " 1,�,, I i k`iKz 's
(Name of Property Owner)
propetty located at 1,17
{.
(Lot, pluck, Road, etc.)
on in, Hclden. &'C'C.h N.C.
(Waterbody) .(Town andfor County)
Applicant's phuno *:Iq } �1ti7 l 4t. Mailing Address: glat_' CCtleti s Cc—*
12t,lt,uh. .Kl 271.,3
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 I boatlift I boathouse
must be set back a minimum distance of fifla n 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 ANDIOR DRAWING OF PROPOSEDDEVELOPMENT:
(To be filled in by individual proposing develapneal)
SEEr1�id
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
MailingAddress
7 I / Signature
7�
City/Stater tp Print or Type Name
Telephone Nub Telephone Number
7
Signature Date Date

cant:
Vv_
Permit #: ` C-1 3792
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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)
Dredge ❑ Fill ❑ Both ❑ Other IV
1 QX
W
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 ❑

R,ic 9-fewett Construction
is or Cinlu 9{ewett
p , 10-842- 17�
1481 Stanbu rryy S
Surp' , NC-8462-6037
Pay to the ! V c (� Ord of /I
V.,)> 44n11AZe
2851
J� 66-112/531
'v -Date
Dollars 8
BRANCH BANKING AND TRUST OOMPANY
I -WO -BANK SOT BBT.eom
For-
,on q � 10 L L 2 11:000 5 1913 38.59 58-