54564D - Roberts

CAMA / __ DREDGE & FILL ,
Pam,
GENERAL PERMIT Previous permit#
4N--Zry JModification ❑Complete Reissue El Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources 2` f I
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �f tj . {' U� �- I
ff i XI Ru es attached.
it Name koo d W V4 Project Location: County �}UISIOW
t ' vm b Q i Street Address/ State Road/ Lot #(s)
State. ZIP ��!(% 1 �6! buwls Uy/teIG
Fax # () Subdivision NIA
zed Agent
❑ CW ❑ EW ❑ PTA &ES [I.PTS
❑ OEA ❑ HHF ❑ IH UBA ❑ N/A
❑ PWS: ❑ FC:
yes (no,,'
no , PNA tides no Crit.Hab. yes / no
none > Adj. W r I t .Body _,U �til
Closest Maj. Wtr. Body_
ZIP
River Basin
if Project/ Activity 1. bys-1 YV r! � n 1 "A) V- A h Q Ct j 1 x ed c !a 1 ✓i Yl
xk) length
n(s) lo'x 1u'
pier(s)
ength
ember
W/ Riprap length
,g distance offshore_
ax distance offshore
:hannel
ibic yards_
mp
use/ Boatlift
Uldozing
IWTWA
7?
ie Length 159
not sure yes
;s: not sure yes
rium: n/a yesyes�
`a es
Attached: yes
(Scale:' Yy
ing permit maybe required by: W.S)o�Z ❑ See note on back regarding River Basin r
(t 1_

19-'2010 11:12 From:DCM MHDCTY
To:91910347074e Page
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATl,IFTBOATI/OII.vF.)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at ( 1�7 �t 1 �
(Lot, Block, Road, etc.)
on.. lA L , in iv
NS N.C.
aterhud
y) (Town and/or Co nty)
Applicant's phone #: 5►t-3Sg. J i Mailing Address:_I; d
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal- 1 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 mc. (If you wish to waive the setback, you must initial the appropriate blank
below.)
T do not wish to waive
I do wish to waive that setback rcquirement-
-------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individualproposing• development)
uniormatlon ror Property Owner Applying
for Permit)
Mailing Address
�Ty -6� Gee 12
5 ti Z� NC
(Riparian Property Owner Information)
Slgnaft=

I-19-L010 11:12 From:DCM MHDCTY To:919103470749 Pa9e:2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORINGPILINGS/BOA TUFTBOATII011SE)
I hereby certify that I own property adjacent to r ,,, r�tr\_ 1� - f> s s
(Name of Property Owner)
property located at Li 5 VA le -e_ L
(Lot, Block, Road, etc.)
On ..ice V h k in 5�� �rca _d N51 �-u� , N.C.
(Waterhody) (Town an /or County)
Applicant's phone #; 910 "3a Mailing Address: 3 s e'e LC
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. 1 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 he filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)1 `-R 1
Mailing Address
1 -:�q 'Ru,vwiP('
(Riparian Property Owner information)
Ra* ")�
Signature
M

4 C Division of Coastal P09t. Habitat Impact Computer Sheet
kpplicant: �}'va Permit* 6� 51V Lf
Date: (_ / ) +/)0
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
'ound in your Habitat code sheet.
Habitat 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 fin
disturbance.
Excludes any
restoration and
temp impact
amount
SH
Dredge ❑ Fill ❑ Both ❑ Other ❑
11513
`5
Dredge ❑ Fill Both ❑ Other ❑
3c
3t
Dredge ❑ Fill ❑ Both ❑ Other
l
I
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 ❑