55899D - Stilwell

AMA / C-'DREDGE & FILL
�E
ENERAL PERMIT
Previous permit#ew
❑Modification Complete Reissue ❑Partial Reissue Date previous permit issued
Frize
d by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC 117.
c
t NamesA✓QQ5/ 71 l i-'F l L
U; GWes attached.
Project Location: County .�,��/r✓Sw���
/ 7 3 % LD.V 6 SAGA - ��t ,
Street Address/ State Road/ Lot #(s) Sj,'57 /ii L
State /e _ ZIP 2 YYiQ
ff (❑//) Fax # O
Subdivision
zed Agentn<J/I/'PS PP
CityZIP
d ❑ CW C-FEW �f"A I+ES ❑ PTS
Phone # () River Basin Lu,
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body nat
❑ PWS: ❑FC:
yes no PNA yes /,. Crit.Hab. yes / no
QQ
Closest Maj. Wtr. Body
A Project/ Activity & 1//4 le
(Scale: /
lock) length S -
pier(s) �r;
length
umber
:adl 'prap length
2 1
"
vg distance offshore
iax distance offshore
channel
ubic yards
imp ti
)use/ Boatlift
Bulldozing
ne Length
not sure yes
gs: not sure yes (3n )
Oum: n/a yes Cn%
N .f) C'/
ryes no
',Q ►'P 1" ��N l C
Attached: yes Cam"
ling permit may be required by: i."" S 4i/C4 COu.� i .� ❑ See note on back regarding River Basin

AMC,- V.-A,
RC'dENR.
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
everly Eaves Perdue James H. Gregson Dee Freer
governor
Director Secre
AGENT AUTHORIZATION FORM
ate: !/-/0—
—1#
ame of Property Owner Applying for Permit:
failing Address:
,3
'hone Number: go
7'10 - ffzwl
certify that I have authorized (agent) C�►t fir` �L'S�P�°- to act on my
Behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
:onstruct (activity)
at (my property located
This ceptificati9rhjs valid thru (date) �0
q 4i
�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
4(Na aS s of Property Owner)
property located at
Block,'f2oad, etc.)
on / , in 6o,11� , N.C.
(Waterbody) (Town and/or County)
�7�%3 Mailing Address:
Applicant's phone #: �
c e Z
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 property owner proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address `J
(! ,WhJte� �. 2W-A -+-V
L-V-vKC0.4l,.r - aw-e
A"rr s
bsev
{uuc.�lE�
r rsr/� sTAIN a
(Riparian Pro a weer Information)
Yv
G
'� Clog roa t o� Signature

- the4svew-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �'✓Gj�-Is
(Name df Property Owner)
property located at Z 9 / J f
ot, Block, Road, etc.
on 3 in 8 u S W I G , N.C.
--�-`T
(Waterbody) (Town andr/'jorr County)
(*jA-7S—J
Mailin Address: /J 'S� �rApplicant's phone g O
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 fillers in by property owner proposing development)
L*T AL 12_ / tier 1 'k3
peve,Le cw+
1i Pee 44%
f,,,,..a U k k-.4
.� o�Ex tirl.-j QlErt yr� IS
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
I ?-3, 5�� D-
Mailing Address'Signature

ICW
3ck
Existing Pier
Proposed vinyl
wall

Division of Coastal Mgt, Habitat Impact Computer Sheet
icant: Permit #: sS-frgy=
//// f/ d
tribe 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 ❑
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 ❑

Mareene Construction
P.O. Box 370
Supply, NC 28462
PAY
TO THE
ORDER OF
dU
10
ss-i i
DATEA/v;/P
i
m BRANCH BANKING AND TRUST COMPANY
t-SM-BANK BBT BBT.eom
FOR � -S�o�e 2/M; _ CAP J u✓�/
Il'0 00104611' 1:0531011211:000510421331El
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