35210

„OCT—OS-03 01:09 PM G.T.WARD,D.D.S
252 92S 5964 P.02
-OCAMA / I DREDGE & FILL NO 35210
GENERAL PERMIT Previous permlt#
New IModi ication F Complete Reissue LJPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission In an area of environmental concern pursuant to I SA NCAC
Applicant Name�t'fo..�,G
Address.. )p F' - r s L 4,19
City-. At q +? Ki `s . Ic-.A,v� _ State Ale— ZJP.W
Phone # (y5 ?- -Of ff Fax #--
Authorized Agent
Affected ` 1CW LIEW i-1PTA L..IES i�PTS
AEC(s), I ' OEA NHF Ca IH Ll UDA -1 N/A
I. 1 PW$:�� f'.ipc:
ORW: yes /no PNA yes / no Crlt. Halls. yes / no
Project Location; County 4. ,♦-rQ�r'4-n er r'
Street Address/ State Road/ Lot
Subdivision
—
City fMK LDS �S[..�1vD ZIP.
Phone # {,� ) . 7.1P-.L`1Sf River Basin
Adj. Wtr, Body, "ghC K Fev (nat /man.. /unkn)
Closest Maj, Wtr, Body
Type of Project/ Activity
(Scslle: )
Pier (dock) length
Platform(&)
Finger pler(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatllft
Beach Bulldozing
Other
Shoreline Length
1`1° 3ti o'
SAV- not sure yes no
Sendbals: not sure yes no
Moratorium: n/a yes no
Photos; yes no
Waiver Attached! yes no
A building permit may be required by:
Noted Special Conditions
.Ape»r pilcant Printe e
Signature "O {ease read compliance statement on back of permit*”'
Application Fee(s) Cheek #
d
or See note on back re-1
L.
arding River Basin rules.
Permit Offleer's Signature
Issuing Date Expiration Date
Local Plannl _..-..._
ng jurisdittion iibver Fila Name

•40CT-03-03 01:09 PM G.T.WARD,D.D.S
252 92S 5964 P.03
ADJACENT I:IPAFIAN PROPERTI' ONNINEI1 STATEMENT
(FOR A PIE17IMOORmG P11-I,VGs1BOATLIFT/B0AT ousaE)
I hereby certify that I own property adjacent to g 04 R(rQ: 164 t ,FJ 44Ds
(Name of Property Owner)
property located at --4L 8'; " 6 *'0' T s e- AAI-P 4,g p ,
(Lot, Block, Road, etc.)
cn8 'K- S4V SiAXO ,in Y.o-Kb'RS r-sL AA/P N.C.
(Watcrbody) (Town and/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 pilingsboatlifVboatbofise
must be set back a minimum distance of ftfteen feet (15) from my area of riparian access finless
waived by me.
I do not wisli to waive the setback requirement.
I do wish to waive that setback requirentent,
•--------------------------------------------------------------------------------------------------------t------
DESCRIPTION AND/OR DRANVING OF PROPOSED DEVELOPMENT:
(To be filled In by individual proposhig development)
-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------
�� 44
Signature
Print or Type Name
Telephone Number
Date.

K - PCT-03-03 01 :09 PM G.T. WARD, D. D. S 252 92S 5964 P. 04
ADJ ACEi1T RIPAMAI PROPERTYOWNER STATEMENT
(FO.ft A PIE)?AJ IDORIiVGPILItVGS/BOATLIFT/BOATHo S,E)
I hereby certify that I own property adjacent to 0 2 g TAOAf.4y (�/,y,�1 Is
(Name of Property Owner)
Property located at F4 Z!S
(Lot, Block, Road, etc.)
on L*L. _ in_ K6-2S N.C.
(Waterbodl') (Town and/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 piIings'boatli"oathouse
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 ilidil,idual prgposhtg development)
i
1
-----------------------------------------•----------------------_.....-----...------------•-----------...._�..._.
I
Signature
i
print or Type Dame
Telephone Number
Date:
Ct-��-p�

MONITORING & COMPLETION REPORT
[CAMA Major Development & State Dredge & Fill Permits]
PERMITTEE'S NAME: I C ( nn, PERMIT # , �--�
LOCATION:
PHONE:
DATE OF INSPECTION
1) Do th Fc'iurr(Ie
ed dime:
YES one].
COMMENT:
6Y,l--D70d
FIELD REP.
DATE REPORTEDLY COMPLETE: -�
the development differ from those indicated in the permit and workplat?
2) SEDIMENTATION & EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? YES/NO [circle one]
COMMENT:
3) FUTURE MO ORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? Y NO [circle one].
COMMENT: