54534D - Renfrow

CAMA / I�]bREDGE & FILL 54
x'ENERAL PERMIT Previous permit#
fAew JM4ification ❑Complete Reissue ❑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 I SA NCAC
Fa!iRUles attached.
Name r! Itzd ✓Cl R -e.�/ f'rzo V Project Location: County -27/ea ✓S�y"C.e
�y
2 �'� `o /�lu�Q i e t Pa. Street Address/ State Road/ Lot #(s) �.� ❑ � Co 0
r�J/t State I'_ ZIP---2 7.10,6 1GfI � Cy+ r i ieo
(�>�) y y •� % %Fax # O Subdivision
:d Agent OAA .e IL City ZIP
❑ CW GEW OPTA --E- ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
PNA y?�-no/ Crit.Hab. yes / no
Phone # ( ) River Basin �lnt
Adj. Wtr. Body A L G✓ (nat rr
Closest Maj. Wtr. Body %�� G✓G/
Project/ Activity o4Z 9 C C C_ r
(Scale:
:k) length
igth
nber
i
IDoprap length_
distance offshore
c distance offshore
annel
is yards
p
;e/ Boatlift
illdozing
Length
not sure yes
not sure yes
?fdy
um: n/a yes
&s}
no
attached: Yes
(!
ig permit maybe required by: u�.tG✓/C� e(Jw,v 411 ❑ See note on back regarding River Basin ru

`...LIE.....
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal. Management
Beverly Eaves Perdue James H. Gregson
Governor plrector
AGENT AUTHORIZATION FORM
Date: S
Name of Property Owner Applying for Permit:
l� ill al e A. ir2
Malling Address:
LArt4p-� pr
aV fe ��e l,/,'
Phone Number-.t"t3}
Dee i=reemai
Secretar
t certify that I have authorized (agent) C /&�S /%/F PY—r to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
construct (activity)
at (my property loc
This certification is valid thru (date) M X, 0
5-�6 -lL/)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property. adjacent to go&L W 's
(Name of Property Owner)
property located at
(Lot, Block, Rondjtc.)
on�.�W (,J , in ol, N.C.
(Waterbody) e ( own and/or County)
Applicant's phone #: 'V oiling Address: A" ] r
' G
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 Or PROPOSED DEVELOPMENT:
J (To be filled in by property owner proposing development)
Ss fL
✓nj! wail
N
PLS1
(Information for Property Owner Applying
for Permit)
I S&,, mar -id
Mailing Address
6 fL/flIbk Z D�
(Riparian Property Ow er Information)
J4, W -
Signature
CG t

icant: �l/�'9r'� %� �r✓7%� "� Permit #:-
/,012 till .0
:vibe 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)
L
Dredge ❑ Fill)( Both ❑ Other ❑
p�
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 ❑

WATERWAY CREATIONS LLC
405 STONE CHIMNEY RD SW BS. 910-619-0655
SUPPLY, NC 28462-2662 11'�Od
'late
Dollars
1559
66-112/531
RA�IM NO D RUST COMPANY •�
1�l00 R04W BBT BBTA m
For