54406D - Harbour

CAMA / DREDGE & FILL
ENERAL PERMIT Previous permit#
'New ❑Modification ❑Complete Reissue ❑fartial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC '-) N . \ ZJ 0
pules attached.
t Name P4g.iS4"a V x LL A„E \` C G-v,fa; Project Location: County PL.: ij (L
•Z (JS LAN)h T w>Cr- 24 Street Address/State Road/Lot#(s)
State Of ZIP 2.-443 ..`,_1 9 kzt.1U L ,vi,,..n>js [La
( ) 7 „ •I b.LL Fax # ( ) Subdivision
zed Agent >Gov G,aR..P€to T i City H-t\i-.p5 tics N ZIP Z. -
L_CW T EW ❑-PTA ❑ES ❑PTS Phone#
d ( ) River Basin e
❑OEA HHF ❑IH ❑UBA ❑N/A ----- '
Adj.Wtr. Body j-ISA z.L %.- (nat
❑ PWS: ❑FC:
yes / no PNA yes /0 Crit.Hab. yes / no Closest Maj.Wtr. Body AT-NA)
f Project/Activity T..r.51 k L t_ y X 1-0 ALA X ..,,.�
(Scale: r
lock)length il A Z 0
rm(s)
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i.nairm.
length — --
camber � iMIMI
:ad/Riprap length 'IMI =10
+vg distance offshore '
181 ai
nax distance offshore
channel � I I amilE 1 ra mom -
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11
:ubic yards —,AU.
witimummem
amp �a�.'_....���� i�=
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ine Length 110 t �gaimmoliEliffAMTIM
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not sure yes no �' !-1111_
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• yes no `+-
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•Attached: yes no - _���—�—MEI_
ling permit may be required by: N.tJ N L a.... vJ\1/ ❑See note on back regarding River Basin
/Cnnriel Cnn.liti..ne

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING P`ILINGS/BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to/ /A U/Gd96.l1" Ae /,3
(Name of Property r (/Vwner)
property located at 20/9 i/t'6-S 4A,JD)dt7- 2 4O jJ411-S7Z / 4/G
(Lot,Block,Road,etc.)
in VA/PAZ -P (isitiNV�) ,N.C.
on (Town and/or Cointy)
(Waterbody)
Applicant's phone#:Cl/D. 2t. •/62 Z Mailing Address: A) Sill -78Z ZB 3
ihagba
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)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) 5747/
,�/8 &DLS �.cJT LOdP /f"'r'. �
Mailing Address Signature
kkinkmaciD A/G _esw3 /��r
., l Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to/141) O n +cN'1
. ' CL u',cj
(Name of Property wner)
property located at 20/9 Ob.)6s &r. )D) /200 ,A
(Lot,Block,Road,etc.)
on
-1-CtA) (4) , in dotvIo9.57 k.) Oirk1Drat) ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone#:qj/D-260- /62 Z Mailing Address:?0 &Jae n h ,,,5> '®-/'UC Z6
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)
(Information for Property Owner Applying (Riparian Pro Owner I f ti
for Permit)
.3/0 C crMM LA000 /
Mailing Address Si
y I'T 99 print or Type Name

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HARBOUR VILLAGE YACHT CLUB
P.O.BOX 788
HAMPSTEAD,NC 28443
Pay to the • "4 Date
Order of — /2_
��ollars
CAROUNA FIRST
HAMPSTEAD,NC 28443
I�
If For ` 7
•:0 5 390 2 19 7i;
� O0 7 2 i 4 50 L8 40
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