42719_COLLINS, MICHAEL_20050829 (2)

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AMA / ❑ DREDGE & FILL N? 42719(
E N E RAL PERMIT Previous permit #
LY'lew F]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As auth/orliized 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 15A NCAC 7H
- es attached.
Applicant Name / " ` I C��� C61/1.pi-f _ Project Location: County 0gA0-C -
Address_S-3 d A j fk 1 ��_ Street Address/ State Road/ Lot #(s)
City(5Tt-CPL,� Oro StateAIC- ZIP V 0 r;t 061 _
Phone # 336) I I Fax # ( ) Subdivision ► r'i} C
Authorized Agent City_ or C> ZIP
Affected El ,lwA El El Phone # (_) River Basin I t�t Ga
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 0�/ )
❑ PWS: ❑FC: I I , natl/man /unkn
ORW: yes no PNA yes no Crit. Hab. yes / no Closest Maj. Wtr. Body "✓ ^ n[ U01C
Type of Project/ Activity S'c✓O C` o p.)4I on dt !:)0A iHyPi- QVId A,44 4r-r-­�
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
I
J �
Shoreline Length
SAM not sure yes
Sandbags: not sure yes
Moratorium: n/a yes
Photos: yes ��YJ
Waiver Attached: ye no
A building permit maybe required by: D„-A M/ CC-
--
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions a h Prn C, PJ !fo "x— /^' ay t %
Agent or Applicant Printed Name
cr/a.1/61F
Signature Please read compliance statement on back of permit Issuing Dat;s pirati.n ate
/on `J 3L a() Oyu( d-'�- ll�po S',art c/A

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
August 29, 2005
Michael Collins
5304 Guida Drive
Greensboro, NC 27410-5206
Dear Mr. Collins:
Attached is General Pernlit #42719C
In order to validate this permit, please sign all three (3) copies as indicated. Retain the white
copy for your files and return the signed yellow and pink copies to us in the enclosed, self-
addressed envelope. If the signed permit copies are not returned to this office before the initiation
of development, you will be working without authorization and will be subject to a Notice of
Violation and subsequent civil penalties.
We appreciate your early attention to this matter.
Sincerely,
Ryan Davenport /lsb
Coastal Management Representative
bp2t�
Enc osures
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

A
Michael L. Collins, D.D.S., P.A.
604 Dolley Madison Road, R0. Box 8145, Greensboro, N.C. 27419
[phone]
FAX Number:[phone]
Fax Cover Sheet
DATE: PAGES (including cover)
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RUG-18-2005 FR1 02:00 PH hurley rover ft Pierce FAX NO. 7724688875
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AUG-19-2005 FRI 01:59 FM hurley rogner ft pierce
DR COLLINS Fax 336-856�0776
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FAX NO. 7724898875
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t%UJ AM li&A\ 1 iW i?a%"- . - - - - - - - - - -
(FOR A PIER/MOORING PIUNGS/B0'47 IFT/BOATHOUSE)
I hereby certify that I own property adjacent to M— i C �a 1 LJ 'S
(Name of property Owner)
ro located at LA 2 � v�'.
P PenY
(L,ot, Block, Road, etc.)
on N.C.
(Waterbody) (Town and/or County)
He has doscnbad 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
pilingslbo4ttMoathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I dalLat wish to waive the setback requirement_
I do wish to waive that setbaek requirement.
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DESCRXPTION AND/OR DRAWrtiG OF PROPOSED DEVELOP'YlLNT.
(To be filled in by ' dDidual proposing development)
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Signature
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Pant or Type Name
Sto- q3 I - 3Ci$y
Telephone Number
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'DR COLLINS Fax:[phone] Aug 24 '05 6:43 P.06

'DR COLLINS Fax:[phone] Aug 24 '05 6:43 P.07
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