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77243_Patrick H. Brown_20200911
CAMA/ ❑DREDGE & FILL - 1# U U)q�Q N9 77243 A ® GENERAL PERMIT Previous permit# NJ ? D e >- T. ew DModthcation DComplete Reissue ElPartial Reissue Date previous permit issued 9V , - —As authorized by the State of North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC U'7 14 ' / 2 -'D . ..&3Ru1es attached. Applicant Name gam,c44 .1- R-, ,-NJ,.) Project Location: County ,yj2A,.., -r---• Address PO Sax -to/ 1.5-q-7 BAy y few, '12 , Street Address/State Road/Lot#(s) - . i i Y City State 144... ZIP Z1 /ra K l [e31 3Ay u/E-1-4-> Phone#(91q)4 24-- R'S'S-E-Mail Subdivision tviw ' " , Authorized Agent .-r-'; r s Mort.et-1-c. City 0r t ZIP 2 1 - t "17k>�- Affected o cw )'EW 'PTA DES OPTS Phone# ( ) River BasirAg'- 6'An..t Ca s : Li OEA 0 HHF D IH 0 USA Q N/A AEC(s): ❑PWS: Adj.Wtr.Body Lj FrzliviLs w-1.4.1 U> (na /man /unkn) ORW: yes nY 9 / PNA ye I. Closest Maj.Wtr.Body ?a/''1 LAv ��`� t Type of Projecctt/Activity ►44 s rt-t- '"rs ' No --`r3 ' Ml co u F t-no "'13vA'T- - -i 1 (Scale: 1 =-•© ) Pier(dock)length _�-_i _ ` l j I I I r Fixed P►atform(s) r - _ ?. j ._i -t i l } - ' .. f , - 3-_ Float'urg Platform(s) r i .r i r i p __ r 1 -i____=--i - .. i ,Goa i--I`' r i ---I--4--i. i-?- Finge lengths) �— ' ` :�rt r 1! ,...i--.�--t- . _ .. i. ' i 1- 1 r 1 f 1i number t l i I j ' j .# �4 � i I j -l--- _I --_ -. .. --_._ +-- -(t? _t C"- I 4-i-- 4- f l Bulkhead/Riprap length -+ ( - } ----- --t.._ _.. ._ 1-.. i_ _..._._I_ avg distance offshore t" f i i 1 I I -.i i L_: + -� �- i — max distance offsho ! { {--I- r i t.._i i - 9�,"1 J I i Basin,channel -3$ _ 1 IT s 1 i + i I � r cubit yards 1 f t$'T ;�- �- _i-_ _ -.r e `j �. .i- ----I....__ - -"I-_..F• ..-i.... ;..._ - r r ` ' . j .. _ Boat ramp _ : • f j�-' t i s kly I = i- i -- Boathous atfl -I { i -. _ j -t-t. .i-. ._� i*, t -*-i'i ._� '- --a-- - -i --.. i � 1- - 1 1 ' _L- '- Q r.tp i- i Beach Bulldozing 1. I I -, - ---1 , ! j. j.� -___ .__ __... ..-_-- { _--1. Other _�.1 - r- ? -, i .1 i 1 . - 4_-2 "4i;- l , ii 1i, 1 lIi 1 , : I �.. j ff 1 7 Shoreline Length� b .T' 1 i i i �r* Ili _., j I . •r..,--�-- +__{----i r ' i { { SAV: yes no __-;_._ -. . . .- - �---i---- _l... . _...... .-k- --' ----' J-4--- 1 -.. . 1 1 . tl ._._I I i � l l i Moratorium: • Na es � �- I • f -T_ -�- i i i Photos: yes I N w L - I i { -. - i r 1 1 - -r 1 r!.no � - "a i A building permit may be required b> A M'F2>►' ,- (,i_ . ❑See note on back regarding River Basin rule. (Note Local Planning Jurisdiction) Notes/Special Conditions Lc -- /S A-tA-i9-7/.}.1l J-t.. Z- L--w rL, r 41J3 .40-1Z VI t.)c e a Printed Na a Permit Kees Printed Name• Signat **Please read compliance statementon back of permit** Signature v 9/1 cil',Y 13--)3 r„ 91•• 123,)-z o / / i, J a z Application Fee(s) Check# Issuing Date Expiration Date 0 CAMA / DREDGE & FILL N° 77243 A C D GENERAL PERMIT Previous permit# ,v /�f-, > New Modification Complete Reissue __Partial Reissue Date previous permit issued r./ lt- --_ --As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC C�-7 14 ' /2--7° . Rules attached. Applicant Name per,e4-F )--,- IZO„1.,1-.1 Project Location: County 3 a -r y r Address Pe" 'END-pc —hd 1 1-5-e1'7 3Ay v rem 1 -J • Street Address/State Road/Lot#(s) ,s,-z. i-7S/‹r City State NIL ZIP Z'' ifag 1 <t39 3,1,7urEw Phone# (g 1 q)4,2¢-.- 9 i 54:E-Mail Subdivision 'aeqtr,1 V'., ' --- -e.1 Authorized Agent — j ,, MAcc.tt-{-e_ City 4774 - ZIP-2-19-0e Affected ❑CW XEW TA ❑ES ❑PTS Phone# ( ) River BasIri PAMZ.t Cc� ❑OEA ❑HHF/_❑IH ❑UBA ❑N/A AEC(s): Adj.Wtr. Body 'a ?Anne,ee-Z.1 il L 4112t, /man /unkn) ❑ PWS: ORW: yes ng PNA ye Closest Maj.Wtr. Body PAM LAC c) .72t%eyt Type of Project/Activity „-1 S-r 1--rs ' >a `4—r , ' l),J co 0 evc.t-- 7 130f1'I-z,,---/.. - 1l (Scale: 1 - -- a/ ) Pier(dock)length r, 1 [` : i ; I I Fixed Platform(s) ,._ I I Floating Platform(s) �'�-az_ afLH �, �! �M t ,C p 1 .�t1� .. --1-- Finger pier(s) (r"1"4-.) .._ ._ - Groin length iiii ; �1 ' ( i I I number — 1 T30f�Tc-,t'-K1` T. Bulkhead/Riprap length — — avg distance offshore ` I j N max distance offsho �0 I Basin,channel Ibests - , I,j 3 S. ---3 9,/- I I j cubic yards { I ; ? ♦ _....__ j Boat ramp �� t fig,rtkt_.s..___ Boathou ,1:..tli _ _ _.._... .-- 1 I E , 13 x ,3 ' i ) r • L.)^1Ga u t'aC O _ il3 x 1"; 1 Beach Bulldozing - Other -2 ! i 1 i 1111 I Shoreline Length ^' to Stu IllI SAV: (not sure yes no - II ——,_\ _ —. Moratorium: n/a yes nor V 1 Photos: yes1 1 N Lv(✓ Waiver Attached: yes no 9 -La 'Ul Lt�w �Q�� 1 ...- -_-_ 1 A building permit may be required by� dQAy-Mo✓►T (_a_ . I I See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions Lv - S I"rA-is'-1-7-440.4- L-4.--1-.-- r--. x, iZ \-4-ti J iivi vc Agent or Applicant Printed Name Permit Kees Printed Name• ,'46 ' ...( 1 Signature **Please read compliance statement on back of permit* ' Signature s /l r✓1-1 Y i 3-t'310 91.• >29 z v 1 / ,, I2_a 2 Application Fee(s) Check# Issuing Date Expiration Date Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s). The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief,certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: Tar-Pamlico River Basin Buffer Rules Other: Neuse River Basin Buffer Rules If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648I) or the Wilmington Regional Office(910-796-72 1 5)for more information on how to comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ I-888-4RCOAST 252-946-648 I Fax: 252-247-3330 Fax: 252-948-0478 (Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde, North of New River Inlet-and Pamlico Tyrrell and Washington Counties) Counties) Elizabeth City District Wilmington District 401 S. Griffin St. 127 Cardinal Drive Ext. Ste. 300 Wilmington, NC 28405-3845 Elizabeth City, NC 27909 910-796-7215 252-264-3901 Fax: 910-395-3964 Fax: 252-264-3723 (Serves: Brunswick, New Hanover, (Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet- Dare,Gates, Pasquotank and Perquimans and Pender Counties) Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 0 2 CAMA/ —DREDGE & FILL I. No 77243 A B C D GENERAL PERMIT r) Ci 0 Previous permit# �� -;New ']Modification ❑Complete Reissue EPartial Reissue Date previous permit issued ==?- As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC • [Z]Rules attached. Applicant Name J�,1 ,!,1 • -, ,,,,, -...' Project Location: County Address i-' "!a,:)x --)0 , I-; i 3A y 2�i • Street Address/State Road/Lot#(s) City + 41-T1 State NJ L ZIP , ,f i ')`i /,/ ; i'_ Phone# (_ , /)4.2-4 - 'ri c'E-Mail Subdivision Authorized Agent --ram 'S i1.'viz,r-t-c City I '-r z> ZIP .;,::.�:�t-�i! , -Ar3 ❑CW XEW `'TA ❑ES CIPTS Phone# ( ) River Basiriz.a- ?P n'\Li r0 Affected ❑OEA ❑HHF ❑IH ❑UBA ❑WA AEC(s): Adj.Wtr. Body a ?4\,, IL., w =1 1,E'c (na,/man /unkn) O PWS: ORW: yes / no PNA yes / no Closest Maj.Wtr. Body �'" I'- ' -'- ,' `'eY` i Type of Project/Activity T z • K- '(Scale: 1 - >a' ) Pier(dock)length . Fixed Platform(s) H. I I I + i j Floating Platform(s) 1 r ` �t ` Finger pier(s) ` 'lf'3-r S�____ �� :.. L _ _.__�.__........... .. Groin length I- '`rt?'I!t number / — _ p '*.1 Bulkhead/Riprap length _.__.._j._........"11 !_ # - • avg distance offshore i, f I V ► _ I max distance offsho e Basin,channel i i "4.', i' I,,, 3 .') --t' V,ja i - yN , , ? cubic yards Boat ramp 1 ; i ,r♦,,,t L Boathouse/Boatli� t i T' ` _ U ev.•-1� .7 - .. r —....._.._A T 3 J JFy. , i . C I Beach Bulldozing Other , { I Shoreline Length f le /'., _ SAV: not sure yes no ` — - I Moratorium: n/a yes ,_Po ` Photos: yes _ , i t}IL =r1 - } . . rWaiver Attached: yes no ' x-� .; 1' ' `t r, 4 ,I] A building permit may be required by-, ,d,4.,t'•r,�s t-r- (n F1 See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions i, ^-^n i )74 Irl-a-,e) 4-�" "1 Agent or Applicant Printed Name PermitOfficer's Printed Name • Signature **Please read compliance statement on back of permit** Signature /,. , � 1 Application Fee(s) Check# Issuing Date Expiration Date Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s). The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief,certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: Tar-Pamlico River Basin Buffer Rules Other: Neuse River Basin Buffer Rules If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the Wilmington Regional Office(9 I 0-796-7215)for more information on how to comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ 1-888-4RCOAST 252-946-6481 Fax: 252-247-3330 Fax: 252-948-0478 (Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde, North of New River Inlet-and Pamlico Tyrrell and Washington Counties) Counties) Elizabeth City District Wilmington District 401 S. Griffin St. I 27 Cardinal Drive Ext. Ste. 300 Wilmington, NC 28405-3845 Elizabeth City, NC 27909 910-796-72I5 252-264-3901 Fax: 910-395-3964 Fax: 252-264-3723 (Serves: Brunswick,New Hanover, (Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet- Dare,Gates, Pasquotank and Perquimans and Pender Counties) Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 eE CAMA / E DREDGE & FILL Na 77243 A B C D GENERAL PERMIT Previous permit# ��-= ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC . ❑Rules attached. Applicant Name Project Location: County Address Street Address/State Road/Lot#(s) City 1.7`1•-•; State ZIP Phone#( ) .. f- • . 11E-Mail Subdivision Authorized Agent ---- City ZIP Affected ❑CW PEW }�' 'PTA ❑ES ❑PTS Phone# ( ) _ River Basin AEC(s): ❑0� III HHF /❑IH ❑UBA ❑N/A Adj.Wtr. Body .. (nat /man /unkn) ❑ PWS: ORW: yes / no PNA yes / no Closest Maj.Wtr. Body Type of Project/Activity (Scale: ) Pier(dock)length 1 Fixed Platform(s) - Floating Platform(s) 9 i I ! �� f!_ } Finger pier(s) Groin length v , ,• I I !Ir i number i-- CI' "+m L ' ! _ i Bulkhead/Riprap length — I— � _.- __ —_.— avg distance offshore t -i I 1 I (i� max distance offshore , 1 1 Basin,channel / r F"I. I' ! i I I N , 1 cubic yards Boat ramp ! "' II j ' Boathouse/Boatlift . j- _._� �__....._,—_- l 1� .. ..- - --.._.. Beach Bulldozing _ i �_ ! Other �� I I 1 ' Shoreline Length is,��r�c..l..C' I . ' I SAV: not sure yes no + _�`�-, I--- - r Moratorium: n/a yes no i -4T .._ — Ai-I.t -r._.; -t- _ - Photos: yes no 1, ,� —_ __ i I mot--- 1_.—. t -? i Waiver Attached: yes no I 1 I A building permit may be required by: ' ' ..+ n See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions i. Agent or Applicant Printed Name Permit Officer's Printed Name Signature **Please read compliance statement on back of permit** Signature Application Fee(s) Check# Issuing Date Expiration Date Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s). The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief,certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: Tar-Pamlico River Basin Buffer Rules Other: Neuse River Basin Buffer Rules If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the Wilmington Regional Office(9 I 0-796-7215)for more information on how to comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ I-888-4RCOAST 252-946-648 I Fax: 252-247-3330 Fax: 252-948-0478 (Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde, North of New River Inlet-and Pamlico Tyrrell and Washington Counties) Counties) Elizabeth City District Wilmington District 401 S. Griffin St. 127 Cardinal Drive Ext. Ste. 300 Wilmington, NC 28405-3845 Elizabeth City, NC 27909 910-796-7215 252-264-3901 Fax: 910-395-3964 Fax: 252-264-3723 (Serves: Brunswick,New Hanover, (Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet- Dare,Gates, Pasquotank and Perquimans and Pender Counties) Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 m(61 Authorized Agent Consent Agreement `'t�J u, re' ck (67d& , herby authorize Tobin Jay Tetterton of (Property Owner(s)) TJ's Marine Construction,LLC to act on my behalf in obtaining CAMA permits for the Iocation listed below. PROPERTY ADDRESS: Car c1:exo , cO c-r-h Nc PROPERTY OWNER'S MAILING ADDRESS: <c G rn � Phone No.q(q' 6 /56 PROPERTY OWNER'S SIGNATURE: / 1? 41) PridtiA. AUTHORIZED AGENT SIGNATURE: .d/t --: �..�%�� T BIN TETTERTON DATE: _7l 2(26 W/Authorized Agent Consent Agree. F N .v • • 'art. �?'. n e '"t« ,� r iu" . , ,,,t, ,:,,_.,' ' 4.'. '" *' '. t:46. : ''4:—:-. :' *. : e i aft - '. i6r k aka al" � "' ;, e �` a-.4 "a .« .• ' ` .. " r s - a 'fir :w • j • . k ,.,g. .1 s° • ,« _ • to s s"s pv e * tea+, lk • { � :• " ; � w ys " .* :Ira:s as • .e s a• '� b 'µin ,.. • ;': s y ..—..` ix. is - .« _ IN Ryy;41, >.1 •4' f....a g, f t 9 .,- , ra +y yt' $,,.. ,.e •s Lr v e a "' a 1. �'' AYirh«a 2 T '" r .'A * r a "', a .** �: a !t. ',p. * it sl i a -rri:. r •'� tr w,;,e' . W. ^ «8 v ' 1 sypr . 6 • ;.� 3A � � .'l,ra, we rw s,' 5 �'sh ,, ..,�' . ®,a r^' t Rs . rp a.q ^as°. °1 ^e 4r sue, .f. �, +[. '$_ • 4 a^4 v � °; t, a a s ,. . a. `f~ R `€ r g e ✓ it �. e ,+ .v � ra A ' a • ti ... 'Mk a� » . r � s . . ti `�s. ' ssn •s `Y» •.a . ,,, � Y Ov a# s , : eaa a • A B , m., ' .• • * Z. a Beaufort County, NC 4. ��� �� � ,9 0...____ Disclamer: 1 Beaufort County online map access is pinvided as a public service,as is,as available and without warranties,expressed or implied.Content published on this websile is for informational purposes only and is not intended to constitute a legal record nor should it be substituted for the advice or services of industry professionals.The County of Beaufort and the Wobsite Provider disclaim all responsibility and legal liability for the content published on this website.The user agrees that Beaufort County and its Assigns shall be held harmless from all I actions,claims,damages ur judgments arising out of the use of County data. i bwulortac.agdmapa.cmn (.1\.' ` 10 m ( Aug/13/2020 � 14014 I Scale 1:517 l ADJACENT RIPARIAN PROPERTY 01% STATEMENT hereby needy that I own property adjacent to % PaY- [di:ea-14i s property located e�3/at U'EUra, ) enedY on Airde. /d 11C/� Add Wai erbody) (City/Town andior Couety) The applicant has described to me,as shown below,the development propaed at the above 0 on. a���.;• ✓ i have no objection to this proposal. �fJti I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (fndiuidciai proposing development must fill in description below or attach a site rdrawinJ) VY6Q-f- Aded7467c, ,r) WAIVER SECTION I understand that a pier, dock,mooring pilings,boat ramp, breakwater, boathouse,IFt or groin must be set back a minimum distance of 15'from my area of riparian access unless waived by • me.(If 1 wish to waive the setback,you mist ink the approerate blank below.) I do wish to waive the 15'smack requirement_ !d®not wish to waive the 15'setback requirement. fprz,perty iDtudub Infemr datlo6V fAd" Property •s Pia ird` oz) 4.4 , P Y-- ; so� &'(JJrs L r LC- Printcr Type Name Print or.Tjpe. me . . 2,41•,cl l S 5 y U.' 2 R cui Mane Address �Ia A dress � ff� z50� ( G NCB C ter,:= . • Cfty/5iateLp ._1I5:5 Telephone Number/email address Telephone,NMmrber/email address rim / Date" (Revised Apo.2014 `'Valid for one calendar year a llt signaiure" ,, /j/ ADJACENT RIPARIAN PROPERTY OWNER STATEMENT t' I hereby certify that I own property adjacent to H / t2 y''' �6 �,� property to ted at �c7 y ��L' w me fo. eperty Owner) Address, Ot Road e on 61 �iGa • JCr'' , in / �� ckd llATJ/ rs (Waterbody) (City/Town and/or County) N v The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) `�� // 8 erg , - — 4°e ,2Qt r� /e'er WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 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 wish to waive the 15'setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) Pgi57oie — Si 'tt�t S� a rePp i i s� %C t1j ri ,git ""e1 or: r�0ir cc, &1 nt o�Type N 7 t P t.r Typ Name v. A, 'U �}� �3�3 9 ai' A d ess ! M ''ng Ad ress - : � ill G 7�0 ft'' )0 c� a 7 ra�''"— City;S e/Zip q iC ty/State/Zi 7i1— -.. �--Ls p favf(j^ 4'€9.Crl Telep ne Number/email address✓A:' ' c d� Telephone Number/email address Date Date* *Valid for one calendar year after signature* (Revised Aug. 2014) NC Divisiorattof Coastal Mgt. Habitat Impact Computer Shut Applicant ? - e C. N 1•A . rz w tJ Date: c1 v General Permit#: _-?'-1 z `/ - — Describe below the HABITAT disturbances for the application. All values should match lie name,and units of measurement found in your Habitat code sheet j TOTAL Sq. Ft FINAL Sq. Ft. j TOTAL Feet ! FINAL Feet (Applied for. (Anticipated final ! (Applied for. (Anticipated final DISTURB TYPE ! Disturbance total disturbance. Disturbance disturbance. Habitat Name I ncludes any Excludes .r/ total Excludes anyChoose One i I anticipated restoration any anticipated restoration and/or restoration or and/or temp restoration or temp impact temp impacts) impact am cunt) temp impacts) ; amount) OPti,1 Dredge❑ Fill❑ Both ❑ Other ❑ 1 9 F l VI.-Ft I I ! _ , I Dredge❑ Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other 0 I j Dredge dge❑ Fill n� Both El. Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑ • i 1 Dredge❑ Fill❑ Both ❑ Other ❑ ! i 1 I I I I i i Dredge 0 Fill❑ Both ❑ Other ❑ Dredge❑ Fitf❑ Both ❑ Other ❑ • i Dredge❑ Fill❑ Both ❑ Other ❑ I • j Dredge❑ Fill❑ Both ❑ Other ❑ I j Dredge❑ Fill❑ Both ❑ Other ❑ Dredge i 1 Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑• Dredge] Fill❑ Both ❑ Other tJ i A