Walker, Dale

CAMA / ❑ DREDGE & FILL No. 75054
.-. 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 15A NCAC
Rules attached.
Applicant Name F ` Project Location: County
Address l r t i ( , , ( Street Address/ State Road/ Lot #(s)
City r l i �1(] - State ZIP
Phone # O( !�,�� �i, E-Mail
Authorized Agent
Affected "" CW NEW JJPTA -1tES ❑PTS
AEC(s):
❑OEA '❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
Subdivision
City S ZIP
Phone# O� River Basin V�I f`rf
Adj. Wtr. Body t r (`/ (nat. /man /unkn)
ORW: yes / no PNA yes / no
Closest Maj. Wtr. Body - 1 ?KI A "
Agent or Applicant Printed Name
Signature .+ Please read compliance statement on back of permit's'
Application Fee(s) Check #
PermitOffcers Printed Name .'t
/ v
SignatYYe
issuing - Expiration Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what Is being proposed, you must notify the Division of Coastal Management (DCM) In
wilting within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 28406-3846. DCM representatives can also be contacted et(910) 796-7216, No response is
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
'S t_t_ z _q
Print or Type Name
213 Lt,1 caryi�c�' !7r
Mailing Address
i4voy kfa�e--
City/stateatp I
Qru- LOot, -bas&
Telephone Number
Date
Information)
or Type Name
Mailing Address
<SI/J�btols
City/state/Zip —�
Telephone Number
-11
Date
Revised 6/18/2012
te7xJ

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: (.Q IQ yr I rI r✓ I I +.tt-I r cd_,.�
(Lot or Street #, Street or Road, City 5 County)
Agent's Name #: Mailing Address:
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you mustnotify the Division of Coastal Management (DCM) In
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive l_xt,
Wilmington, NC, 28405.3845, DCM representatives can also be contacted at [phone], No response Is
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 1& setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
NA �
CSignatur
5u,L V l lJ� 1(<t r
Print or Type Name
.2j3 C,%cy-olc L0
Mailing Address
i+-AV P;dq�c-, uC-- 100
City/State&ip
C)Iq Laos
Telephone Number
-1 / .z 7 / Ice
(Adjacent Property Owner Infor tion)
re��—
Printor T s Name
.:? &) / A ct cc F'
Mailing Address
le FPd v �V �r Z ��d
City/State/Zip
Telephone Number
Date — Date
Revised 6/18/2012