54444D - Roberts

CAMA / DREDGE & FILL
iENERAL PERMIT Previous permit#
New ❑Modification DComplete Reissue ❑Partial Reissue Date previous permit issued
ized by the•State of North Carolina, Department of Environment and Natural Resources l'
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC T t� • j
Rules attached
it Name t"
6
_ State N C ZIP Z46b
E On) L1-4 �� Fax # ( )
ted Agent
CW ' 7 EW ❑ PTA WE L] PTS
OEA HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑F/C: _
yes '/ no PNA yes
Project/ Activity
tiXl1A 1, i, �'kllIG►1 rv)
ck) length
F pier(s)
length
lumber
ead/ Riprap length
tvg distance offshore
nax distance offshore=
channel
:ubic yards
amp
Ouse/ Boatlift
Bulldozing
ine Length 1 V 1 ��
not sure ves C. .
Crit.Hab. yes ! no
igs: not sure yes �no
arium: (/a no
yes
r Attached: yes C no� �
ling permit may be required by: QW �✓
Project Location: County Yl C ve k
Street Address/ State Road/ Lot #(s)
a"'i5 MaYsh Hkh DrlvG
Subdivision l., kQ M rV Vev1
City I I Ti Yl ZIP 2'4(
Phone # ( A i►tf River Basin-4
Adj. Wtr. Body (,l nat
Closest Maj. Wtr. Body 6()VV1k
(Scale: `
❑ See note on back regarding River Basin
Ga_ —I —_.I.1_.. I P.li 1,.
III h A. A III ,A ,„ I t--f , l '�111-, I. „ .. J

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Z�L t" �/ ��,►� b 's
(Name of Property Owner)
,roperty located at D h.
(Lot, Block, Road, etc.)
n _L�4 c_N,io �� a+� �',vg ( , _ �^✓i�l+� /d> (iU , N.C.
(Waterbody) (Town and/or County)
kpplicant's phone #: 3 oaf Mailing Address: ��7— GS
le has described to me, as shown below, the development he is proposing at that location, and, I have
.o 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)
failing Address —"
(Riparian Property Owner Information)
Signature
'ity/State/Zip J
'
Print or Tvne Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to is
(Name of Property Owner)
property located at a a S U j-N .
(Lot, Block, Road, e\t�.)
on ,in %M\13 0e_y-_ ,N.C.
(Waterbody) (Town and/or County) \\
Applicant's phone #: '�\'Q `�� 3`l `a1� Mailing Address-`` �aS \('�s� H�v�"
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:
I (To be filled in by individual proposing development) 1
✓2 1Ni2n^ tJ CoNj��� C� O� Y\e�•.` A_V_ �'le �o� O�.r¢c 1Itv
(Information for Property Owner/Applicant
Applying for permit)
,�),aS 'C'c\s�.
Mailing Address
TVA�,� _ �� C)
City/State/Zip
(Riparian Property Owner Information)
Signature
Print or Tvne Name

Division of Coastal Mgt. Habitat Impact Computer Sheet
ilicant: --00b 5�-i Li L
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
bitat Name
Choose
One
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
�6 Dredge ❑
Fill)4
Both ❑
Other ❑
((0
110
Dredge ❑
Fill ❑
Both ❑
Other
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
u
Other ❑
_
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
��l`M1NS w �� ,C • �`gy.��
2. Article Number
(Transfer from service label)
A. Signature
�7-� ❑ Agent
X ` v, ❑ Addressee
B. Receiv y (Printed Name) C. ty of Delivery
�/
D. Is delivery address different from item 1? 0 Yes
If YES, enter delivery address below: ❑ No
3...Service Type
✓✓Certified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7009 1680 0001 8819 7292
PS Form 3811, February 2004 Domestic Return Receipt
Dredge ❑ Fill 0 Both ❑ Other ❑
102595.024A-1540

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