50362D - Rouse

CAMA/ ❑DREDGE & FILL
3ENERAL 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
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC • t�-�
Rules attached.
It Name be.At i _ C ks-' Project Location: County ,:f.7v .1-. LA.)
0. 1 b X 1 64, Street Address/State Road/Lot#(s)
}i N K. 1-1 1 t—t.._ State NC. ZIP. S7 , 349 C Hp,d w i CrZ SkC E 3
P? -2.)93 1 7.967Fax#( ) Subdivision �ision C-1 /N�,w IC-K St-it r3� y,
ted Agent City ✓N ct. 'Fe r r�-� ZIP 2.8
I ❑CW ❑EW IPTA ❑ES PTS Phone# ( 1f13`-t•52)8-7 River Basin l%•Vr
❑OEA ❑HHF ❑IH `.UBA ❑N/A
Adj.Wtr. Body LA 1-1-1 . IT I
❑ PWS: ❑FC: ` (�
yes no PNA ye no/ no Crit.Hab. yes . Closest Maj.Wtr. Body Nc lZ- t 1
f Project/Activity Efro\I E.. p!71Q.T1 QY\ UP 'FX% ST1 tv(s 'F__f>tTf of wm, AND
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g distance offshore ID #— -
ax distance offshore -� EX '5`TI
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not sure yes G : ,
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Attached: yes a) ,
ing permit may be required by: [e)N rjtcj LA.J ( (/ u KJ 7 . n See note on back regarding River Basin r
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7UNITEDST/JTES . is-s00
POSTLILSERVICE® POSTAL MONEY ORDER 000
SERIAL NUMBER YEAR, MONTH, DAY POST OFFICE U.S.DOLLARS AND CENTS
'J24993177 500
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/03/2008 09:43 252-5E8-3982 JOHN SMITH CPA PAGE 02
'03-2003 09:15 From!
Tc-252 5E8 3982 P.2/5
1T s 5Q36
_ G,AMA/ Ci DREDGE F144
GEN EF LAL PERMIT
cPrevious permit# N.
-
New II1Mtrdlficstion DComplete Reissue f7Pardal Reissue
Date previous permit issuod _ _
mooted by the Stale of North Carolina,Deparomont of Environment and Natural Resources
iho Coastal Resourciss Commission in an area of environmental cpxom pursuant to 15A NCAC,_ aenchon.
Pro der Location; County ONE . ----
Street Address/Sena Road/Lot#(s)
.F01>1,NCi lik
L- Subdivision„G4 8,w 1, _... -5- __.
�,� ). fix+� � __._�.._ _ _ �1
wind 0Agent _ _ City._ N c.ZaZ. rr' , Z P
--; --- ITS Phone# ,' .17 River Basin lAsi_cktdCa
tree cFA LI HHV n IMl LI use is N/A Adj.Wtr. Body ., i�L��C 9-0
'�s)' a revs ..«.�..— tJPc: - C kasOSt Mal.Wtr.Body ..:.. -�-- i.v.e C —
N: yes CD PNA 1 no Crie.Hab. yes Os
pe ot,meat/Acd, ,► 0 , AND
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awm7ber -
.k ilk head/RiprsP t�8th _ _ �
Rya jaantn offshore .. ... . r r Ito fkZ ^ a ..r, i .. ...
MAX ddaaneo olTerx re > - - is.,
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hall,channel --- - _ lar ., � � .. - ' i .,
stert•
loot ramp - _. x ( l j 4 4.(JJ •fl2 � _ .r ,_
loadiou�l BeatllItt - -
leach Rulldosind ___ .4 . . I
paler' t t'os--K_. ; • - ,.. ..� .. _ ,. .. _ - Y
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Mornmrlum: Ns I , F 1�. ���'��'' t _
Photos4 ro, l - 4. 1-C. 0MS C`i��' . - -.
W alwr Mooed. ..._.,e� J -...,..
A building permit may be required by_ N.S. c,,,_il -..ccO F I Soo nom on hick regarding River Basin ruins.
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Notes/Special ecial Cant Woos WC_ '�''�'PS SI- 1..�
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to DEN Rou se 6W\910 O\Te-
(Name of Property Owner)
property located at 3 7 9 Cf Aa'wl c-k- $f ,2-t
(Lot, Block,Road,etc.)
on �r,!//E!2- �/LE�� , in 5.NEACIS /.rr — OA/Sk ,N.C.
(Waterbody) (Town andTor County)
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)
9 pOcT: .
2" c&)
i a 1 b ylt,. '""-‘
•
40' ;-1710 5a -r v/AI
_ J

.
' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
certify property �D E`A Ni -.R C ° 1
I herebythat I ownadjacent to o�S t Col��
(Name of Property Owner)
property located at 3 Ai q Chad W 1-0 _ 5 Htrle 0 Rw E
(Lot, Block, Road,etc.)
on A// a Ca.E. -)c , in 5\ftl /d..i — U�J/oH/ ,N.C.
(Waterbody) (Town an or County)
He has described to me, as shown below, the development he is proposing at that location, and, I
L tion3 to his . 1ndlerstnn'1that a pier/mooring pilings /boatlift/boathouse
late no ov3�c�ivii:, proposal. I5.==...._�.,...,.,. pier/mooring pilings
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.)
do not wish to waive I e
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
± (31o© pil_Op OS ed 3c_*
I S M 1 "
o ✓- -- Co
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