54098D - Tewksbury

Street Address/ State Road/ Lot #(s)
Subdivision t vfiGt (Y1
City O-Mid � ✓Y ZIP
Phone # ! o ) 3; -- - CC) y4 River Basin Q W
Adj. Wtr. Body Q W klvw nat
Closest Maj. Wtr. Body 0 W
(Scale: (>/
CAMA / DREDGE & FILL
3"E N E RAL PERMIT Previous permit #
(New ❑ Modification []Complete Reissue [-]Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources i
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
+es attached.
it Name ��� i'i Project Location: County �CW (JYi
StateN(- ZIP )IN&G
# Fax #( )
ized Agent ~ 7{Vy- �/� V iY
d CW : EW >(PTA C ES PTS
OEA HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑FC:
yes / no PNA yes & Crit.Hab. yes / no
lof Project/ Activity
dock) length
r pier(s)
i length
number
ead/ Ripraplength
avg distance offshore
max distance offshore
channel
cubic yards
amp
ouse/ Boatlift X
Z'
i Bulldozing
line Length
not sure
yes
(ten
ags: not sure
yes
! n
orium: n/a
yes
n
s:
yes
rH
r Attached:
yes
n<
ding permit may be requi

308 15:19 From_DCM MHD 25224(: 30 !o:yluserecSH( P.'r'
A V.I %%-AJ,I L 1\L1♦%/•1At-II A a..i+-++ `I r•a-— —w--- — +
(FOR A .PIERAIOORMG PILINGS/BOATLIF71BOATHOUSE)
I hereby certify that Town property adjacent to
(Name of Property Owner)
roperty located at Z3+ - /li,SZDnC
(Lot, Block, Road, etc.)
n /`lea ) ,01(C-)A , in , N.C.
(Waterbody) (Town and/or Co ty)
Ee has described to me, as shown below, the development he is proposing at tha: location,
id, I have no objections to his proposal. I understand that a pier/mooring pilings/lioath R/boathouse
Lust be set back a minimum distance of fifteen feet (15') from my area of riparian acc;ss unless
'aived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOFMEN1
(To be filled in by, individual proposi [IcwElopttteirt)
fi �-,Qot--� to
1-0
4/ �� k_
t Pylons
Jr
-IN ' (I V �L /i EI�
kpplicant Information) (Riparian Property Owner Information)
deal 'SZa1

HF-06-2eOe 15: 19 Fr om: tkJ4 MHD 'c1bed'47.:S SM I c : 910SC r2St3
!'?YIIA\r Lla , J a4a • aa'U.t • !. a a ua�a a v r . .ua• y n • • a u- aaia
(FOR A PIERIA OORIXG PILINGSIROATLIFTIBOATHOUSE)
hereby certify that T own property adjacent to Te_ T, E,i
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on I�EU: & t Y , in s i t ► < GLG.E� � N.C.
(Waterbody) ('town and/or Co
He ;,as described to me. as shown below, the development he is proposing at tha: location,
and,[ have no objections to his proposal. I understand that a pier/mooring pilings/l)oatliR/F-,whouse
must be set back a minimum distance of Fifteen feet (IS') from my area of riparian ace-ss unless
waived by me.
_x I do not wish to waive the sethack requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by' iiulividctail proposigg tic Vellopmell I)
-------------------------------------------------
(Applicant Information)
1•�-lp �rr��J7 �j�/JY V�i
,Vailing Address
=� /WC s
Ciry/.Sratefzip
Tvlephone Nmnber
Date
�y�ons
(Riparian -property Ow nforma:ion)
Prin! (jr Type Maine
f / 1 -%%s -4c'
Telephurre Number O
Dwe

C Division of Coastal Mgt- Habitat impact Computer Sheet
piicAnt:
U
Ite:
for the application. All values should match the name, and units of measurement
:scribe below the HABITAT disturbances
and 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
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
abitat Name Choose One
includes any
anticipated
restoration
any anticipated
restoration and/c
restoration or
and/or temp
restoration or
temp impact
f- imnactc)
impact amount)
temp impacts
amount
Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑
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Dredge ❑
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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 ❑