45919D - Brooks

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LAMA/ ❑DREDGE & FILL 1 i
IENERAL PERMIT Previous permit#
4ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
!ed by the State of North Carolina,Department of Environment and Natural Resources 2.__ED�
>astal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1.1 • I
]Rules attached.
Name W=1.I,.T i\rr Ij 4... k- Project Location: County ®w )(.,,p‘.--)
2,1., i n(?-w 0' b%L Street Address/State Road/Lot#(s)
V L FC. State QC- ZIP L SHIL(i Zj� �j '. Ji
;c"11•b) 2$5`-Lt j3 O Fax#( ) Subdivision
d Agent City' L-ii(!.F G,Z( 1 ZIP Z$L1 u
SE❑CW W PLIA ❑ES ❑PTS Phone# ( ) I River Basin( f PE 1
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Bodyfl m Q so v• 'atj (L'''"'` (nat
❑ PWS: ❑FC: AT W /
es / no: PNA yes / Crit.Hab. yes / no Closest Maj.Wtr. Body .,/
project/Activity `r N. j L L (4 V t:Vf., Pi%. .s'V=►-1 r A NJ p\-I,
5 sL' C.'` T ►-.) \ 1 , X I= Cr L 1L (Scale: I ` =
;)length
r(s) 1
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ber ( 1
ET CA i!I�
Riprap length �._._._
dstance offshore T
. T
distance offshore ._..
nnel ( f
.
g 4
yards 1
3/Boadift 4 \ i j 1
(dozing
i is
f
Length J �i ' i qXl'i-riN*►6, 1_...__
not sure yes QI i ` �?
not sure yes 0'
1 -....... —_
�_ w �— .
im: n/a yes ,no
yes — — t
tached: yes
f /'

•
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�aa-�r�c:ter �zr�ar
"10 WILLIAM K.BROOKS 9402
_. .' __ SAND AND GRAVEL COMPANY 66-112/531
1 i 1 I I: �l A NCDL 2129733 NCDL 420899
BRANCH 02601
' a `. • > 122 Dogwood Dr '
Wallace,NC 28466 _
Ph.910-285-4330 or 910-285-6606 DATE
"a PAYl
12
TO THE
ORDER OF//�/�` p'-17, I $ /(11) I!I
DOLLARS el �:..•'
EMUTA
yl BRANCH BANKING AND TRUST COMPANY
1-800•BANK BB!BBT.com I•1
FOR 4•P ; 1?\
NP
100000 9110 211 CO 5 3 LOLL 2 L.:000 5 L L 308 700 711'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 'I/I cc r1,1 l< (3t'e©/' 5 's
(Name of Property Owner)
property located at 0 >0 3)
(Lot, Block, Road, etc.) y 016 IsUA-)
on ,in t' ( ' ( ,N.C.
(Waterbody) (Town afid/or 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.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
We QA;fk )
o IS
S.gnature
Pri or Tvoe Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOAT/UIFTBOATHOUSE)
I hereby certify that I own property adjacent to l/1/;I ) .dlr`'1 K 13ro©6S 's
(Name of Property Owner)
property located at 30 .50 3 Po 54Peet
(Lot,Block,Road,etc.) 0 r s
on ,in €2i` C C ,N.C.
(Waterbody) (Town and/dr 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/boatliftlboathouse
must be set back a minimum distance of fifteen feet(15') from my area of riparian access unless
waived 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 DEVELOPMENT:
(To be filled in by individual proposing development)
at./ ?; I ; nk>
NO. _ 2 .'0-r-
fix:-�;t\e", ; 8
ivy-
Gj o ► ; ;4.c) Imo— 1 3 —1
c:.,4•:
Signature
' ti)- td‘4-
Print or vne Name