53946D - Williamson

AMA / I DREDGE & FILL
E N E RAL PERMIT Previous permit#
ew '_Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources ��//
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 2!I'. /I 00
t Name �o G(7, L C9 Rules attached.
i i4 A7 se^/ Project Location: County�,q s. v S w,c k
d. ,l�jp X 73— Street Address/State Road/Lot#(s) /2/9 �eA,
h��lio I/ e Stated ZI P2 B t/s� 5 7:
it ( )536-35 33—Fax#( ) Subdivision
zed Agent t yn", 144+vfQn. City a 04.i,7s/t 6f/jc A ZIP 2C-Y1
d a.CW ❑SW EPTA [ -ES OPTS Phone#
( ) River Basin 1 yry I
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body /52/hI h/ L(nat
❑ PWS: ❑FC:
yes / ) PNA ./ no Crit.Hab. yes / no Closest Maj.Wtr. Body ��Gt/�✓
Df Project/Activity �R,U 4r71 9 IN Lk1 pe9 8
(Scale:// :
Jock)length ....--- N...., 9, .,,, „------
rm(5)_ T—__ — All i —�.-- ,i _ —1
-pier(s) _ y
length I: �Lt i F. i
J .20/L/ -
number � 0 � � i ,
ead/ iprap length 7 -}0/2 ,1✓ . a..491 q t ,<?_- ' •
avg distance offshore -$ tt te '` 1 ,l g.ri" �r /r /�
max distance offshore -g-' t� I / ' 4 -
channel ill riff Mi I
cubic yards j ,� 1 1
amp ✓ V
louse/Boatlift i
O Z'iYa,_ Mil
—
I Bulldozing ( , p ec/( I
_ — 91 H -
_ --l4W1
ine Length C i
f j
not sure yes 11 V
ags: not sure yes 6i2
:orium: n/a yes Op 110
s: yes 4no / I.,'
r Attached: yes �=2, - 7)9 �Pn?,,- w 9 ,
ding permit may be required by: A-404 1 S L.P 6,/9 c A n See note on back regarding River Basin
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A774.,,AA,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
?verly Eaves Perdue James H. Gregson Dee Freer
overnor Director Secre'
AGENT AUTHORIZATION FORM
ite: -��
tme of Property Owner Applying for Permit:
ie` k �II,
. lY �a rrtsvA)
ailing Address:
PO, asc I9g5
$Agll/�� Al C-
lone Number: (`lib ) 53Ce - 3535
certify that I have authorized (agent) pko-iti Cop to act on my
shalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
Dnstruct (activity) bull<heitice
t (my property located at) / 719' /1e/11 z ). $f 67,T,87 q61"
'his certification is valid thru (date)

— vtn.,�
' J
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Kelly l:A L 50N 's
(dame of Property Owner)
property located at 1-.071- SeccAia T y )N )A S+
(Ldt,Bloc ,Road, etc)
on .I( , in O.T . (-'0)$Cc1 C„N.C.
(Waterbody) (Town and/or County)
Applicant's phone#:T O-5 353.E Mailing Address: P ok 1536
Si,Q//6 t /AV C 2 ?
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 (Riparian Property Owner Information)
for Permit)
Pv 01 lScS OtA46 (4.
Mailing Address Signature
r'r �1

✓cam
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to d I tf WI I I i Q m5 O is
(Nathe of Property Owner)
property located at — �t�y Big t� I
O� � Se� I 19 ft eel'►JgW '
(Lot;Block!Road, etc.)
g
on �C� �z,in � rUA1,SGcJ i c/'�- CO ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone#: 1I0 53( 3533 Mailing Address:Pa BOk 685
shallaffe�� q5q
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 (Riparian Property Owner Information)
for Permit)
10 4.61( / 5�6 5' (1)A- -IsPaje.
Mailing Address Signature
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