41451D - Potter

ICAMA/ l DREDGE & FILL j T A
iEN ERAL PERMIT Previous permit#
LNew iModification IComplete Reissue I—Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources I
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC I . 1 Z-,5
"TVRules attached.
:Name ' w 0 C LLS�T ell t o Project Location: County O w S t_J.--'
-7 0 3 L "` ' 1 - Street Address/State Road/Lot#(s)
N+.(-- .T*j
State 1)C_ ZIP 29)9 Ns-' -7 ,_,3 L. 7 t `' 5--
1 2 )3Z - 43S2 Fax#( ) Subdivision O\ 6 cb.,1h\, c 5 -5�0 c
?dAgent ( :0 441 Npt,,sF IV) A4--r, City 5u(1 LTV ZIP 239L !
❑CW W PTA7 ES ❑PTS Phone# ( ) - River Basints,PL (
❑OEA ❑HHF ❑IH C.UBA ❑N/A
III Pws: El FC: Adj.Wtr. Body 0,4)0»L ON
yes "no PNA yes / no Crit. Hab. yes / no Closest Maj.Wtr. Body A I,4/vs('
Project/Activity i ) \�t \ 2_ 5._-,. , Z ' x Z Z' At_c .ss 4.,t 2
(Scale: // 2
:k)length Z., x L Z
(s)_
er(s)
Igth
nber
I/Riprap length _
distance offshore
K distance offshore
annel _
sic yards
ip
�/Boatli I I, i 2. .___.---___
L'
dldozing 1 c
,___
,-i
t
Length 0' Q.bo
{
dap yes no
: not sure yes nn
urn: n/a yes O P P
L.
•
yes no
ttached: C) no
ig permit may be required by: j,\ i2.V' L.i, -j See note on back regarding River Basin ru

@4/11/2005 19:38 3537316 JDNEWE PAID @4
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04/11/2005 19:38 3537316 JDNEWS PAt;E
ADJACENT PROPERTY OWNER STATEMENT
i t icreby certify that I own property adjacont to �/ a�N a 4-.�f (r J P7)Z-7/(_z_._
(Name of Property Owner)
property located at—_ - 1.. --- . __ . .____.. .--
(Lo/t, Block, Road, etc.) � ) r
on �t-k CfA,JGi 01 .0 �- 5:e4c;tin, t�! 4 c� Yy. c` zc
�,!
(Waterbody) (Town andycr 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
)12..opose9 )(-) c., i 92_ , -Go I tow; e)s
fiJ S 1 r! - ` o ) O 4b O 44-
r -74 � � A-ici d o � c 4- c) D(ct�
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Signature
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y44f2L Phnt or Type Name
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Telephone Number-

04/11/2095 19:38 3537316 JDNEWS PA' 05
Aldr 11 OE 09e013p Yvonne MOLamb 919-729-0110 p, 2
e4/10/2D95 21:5B 3537316 JDNEIJS PALE 02
ADJACENT PROPERTY OWNER STATEMENT
I 110-oby certiry that I own property adjacent to_ _4r'a tT
'`y * rvarnv of Property Owner)
J property located at 0 8 ), ./
;Lot, Block.
{?�oad,,,et(c.)
CA
(Waterbody) Crown andtvr County)
I-le has deecrtbed to me as shown below,the development he is proposing at that location.
and . ' have no objeCtIor s to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be tilled in by individual proposing development)
(PP_CRO prOP24—+ C.-1 pe.. ..s -cco
s4 1(A a .J o o c#
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IS
ipapature
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Print or type Name
Telephone Number /
bate: Z 5'777/ e1

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