52477D - Floyd

CAMA / DREDGE & FILL
ENERAL PERMIT Previous permit#
mew El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 2}1, I,O O
/ D.Rules attached.
nt Name - (. Z. Q,i dr Project Location: County la.,—c:,,,= 'c-
s__7 y V 6 3 ri ,i / r/-0. Street Address/State Road/Lot#(s) %',-,-,,--
1)..),C/ State I C. ZIP S'/2
# ( )1/ Jp/ Fax#( ) Subdivision
ized Agent r,t /s /" 4r/Pr• City ZIP
r-- ❑EW ❑PTA DES ❑PTS Phone# ( ) River Basin Lei,..,
d
OEA ❑HHF ❑IH ❑UBA ❑N/A
Pws: ❑Fc: Adj.Wtr. Body A v' ,-,/ ( at
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body /9//„/
of Project/Activity /.,v i 3r2 I d/I/r �y e. ,,eA Q,¢+I
(Scale:/_
dock)length -,�, 5��. i
J I I I / I
irm(s) i rY�
1 'v
r pier(s) ,
i
1 length St
number
ead/Riprap length J 9 ' -_' _.i��,_ !.__ 11111]
avg distance offshore-�' iiiiiiiflui
max distance offshore -
channel
cubic yards r
ramp
louse/Boatlift
i Bulldozing II III ill
I' ll
IS
I I
line Length
not sure y
ags: not sure yes ‘ffQ-' j i
orium: n/a yes t_no-' f� , !IF ✓J IIII
s: yes cs-:;.
r Attached: yes �J I
ding permit may be required by: .e2 c+".ss-✓iG k r,,.I r *fy I See note on back regarding River Basin
'^ !i / 1 _l -1 / >^ i , i . _. _ . .

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Si D
J._
(Name of Pfoperty Owner)
property located at pZ"1 -SigAiNto..
/ (Lot,Block,Road, etc.)
on �f- e W , in_ CtMrjW�C. 1G.. ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone#:?/V S it Z . s 20/Mailing Address: Z /c/( ' .Lc A.-
S'10 p t y
He has described to me, as shown below,the development he is proposing at that location, and,I
have no objections to his proposal.I 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 be filled in by individual proposing development)
7S '
�Ji,rt�c4 �
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
LAIC, 1 VIM r i
v
(V)
Mailing Address Signature
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WHITETAIL:DEER
HOLDEN DOCK & BULKHEADS
GREGORY A & DOROTHY HOLDEN 3335
910-842-9732 HIS NCDL 4576438 HERS 5202642
1502 STONE CHIMNEY RD SW Z / 66-12I5/531
SUPPLY, NC 28462 / 840
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u:053iL2L521:8000L57530003335
RaMa,W Claha WILDLIFE PORTRAITSIp
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