61651D - Owens

Ceti �-NS �T
LAMA / DREDGE & FILL M 61
GENERAL PERMIT Previous permit # '�'
]New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rued by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC '
❑ Pules attached.
nt Name_ I t Project Location: County i
s I d Street Address/ State Road/ Lot #(s)
State NC..ZIP 76 3c?
Fax # ( ) Subdi 'on
--4
ized Agent } o i - Lr City i L'A ZIP
T
d 71 CW 12 EW r4 PTA ❑ ES ❑ PTS Phone # ( ) /, ► iver Basin
�
OEA ❑ HHF ❑ N ❑ UBA El Adj. Wtr. Body W at
PWS: ❑ FC:
yes { ho PNA C 7 no Crit.Hab. yes 'C; J' Closest Maj. Wtr. Body
A Project/ Activity
ock) length m(s) ln �/ � ! O
piers)
length
umber
gad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
,us atli �? j�Z
ne Length ✓ r
notsure yes no
cgs: not sure yes no
>rium: n/a yes no
yes no
I.
Attached: yes t
ling permit may be required by:
/ C--- :_1 1AA
0
`s\ ( 2-
(Scale:
T t U Vy 1 .,��. / •\ LJ,§ee n{dt% ba k�r�g8fding*ver Basin

giant: 4 Vu C/1/t S I
Permit #:
5(3c/ '--z'
ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
in your Habitat code sheet.
DISTURB TYPE
it Name Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft- TOTAL Feet
(Anticipated fnal (Applied for.
disturbance_ Disturbance
Excludes any total includes
restoration any anticipated
and/or temp restoration or
impact amount) temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
.)
4/ Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
r
QaJ'71
2. Article Number
(Transfer from service label)
A. Sig ture
X z /k ❑agent
C�J Addressee
13 scelved by (Printe ame) C. Date of Delivery
D. Is delivery address different from Rem 11 ❑ YY s
If YES, enter delivery address below: LSd'No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery's (Extra Fee) ❑ Yes
7012 2920 0001 .3990 4296
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M-1540

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
et
Owner's ailing Address:
J�
o
Phone Number
Agent's Mailing Address:
Aq [ *1, % AV,' N
/1, (- -
Phone Number( N) 3 76 — S q 7�
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at
This certification is valid thru (date) , f--I I/----

U2013 . 10:05 LOUe Koerog
(FAH)910 327 01 P.001 !
ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PeRMITS
I hareby certify that I own property adjacent to „ C�'L�l. _ - $
(Name of Property Owner)
property located at ~ +10---
Address, Lot, Block, goad, etc.)
on.... »G�14�Lia�7:�? In /�rw N.C.
(Weterbody) (Town andlor County)
He has dQsaribed to fie as shown In the Stttdchad application and pnq Kt dr61011g(a), chit development
he is proposing at that iocation, and, i have no objections to his propool.
�APP It;ATIO AN WING OEPRQ.E"f,9 n.�.VEi,dE'PNT B TAC l
S ` t r
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Print or type Name
©7 l Telephone Number
DDate
FO43?
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