Gombar, Bruce

❑ CAMA / ❑ DREDGE & FILL
No. 74440 A B (C) D
®GENERAL PERMIT Previous permit#
_]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorizbd by the State of North Carolina, Department of Environmental Quality
the Coastal Resources Commission ill, an area of environrpental concern pursuant to 15A NCAC coS/
j
,.,❑ Rues attached.
Applicant Name j" 'r 1 ,)` , E ` Project Location: County lam'✓ i
Address i'1 j F ( Street Address/ State Ro d/ Lot #(s)
City State ZIP c..
Phone # ' 1 S
( ) 'E-Mail
Authorized Agent 1, i '
Affected ❑CW ❑EW Aff PTA ❑ES ❑PTS
AEC(s): 7 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS:
ORW: yes / no PNA yes / no
Subdivision
City Ile ZIP i- �f
Phone# O-River Basin j�'r l
i
Adj. Wtr. Body �`' �-le(Aaf /Man /unkn)
Closest Maj. Wtr. Body
■■■■■■■
■■ME NNHN■■■■NM ■■■■ ■■■
ME■■■MEMO.
■w■■■MM■■■■
■B■■NMMOM■■■�
ME1:®■■i:■�■■.�C...�:�:
■■■■■ MEN ■M■ ■■■
O■■■■ SEE ■N■■■■■■... . .
■a■■
OMEN..
SEE
■■MMEN
■■■■■■N■■■■MNNM
■A■OMM■
■■■■■■■.■■■M■■N■■■■..■.■■.■.■
■■
■■■■.■.■.■■..
MEMO
.■MEN
No.■■■■.N.■�
■■O■■1..
■C■.■.O■..■■■■.■■■■
No
ME
■MMO■N
■■■■O■■N■E■I■■■.■■.■.■■...■■.■
■E
::'=_�
a:::::MEMNON'
■■■■■■N■MMt3■111�i11�1C►A�ltil...■■..
O■■NNSENSE:
::M■EONE
:
:::�::I.,::::::::
■■E■■■■NEEEE■■■N■'Mlu■■N■■■■N■■O■N
V
■■■
O■■■■■■NNNI
NN■:: \N:OsoE:8::'■�/M:::®:l
Ms:: E:. :
` OMN■■E■■■N
::\11::
Nn■■■■IU6/ MIREi.flilMEN ■M■■■■M■■■■■■
' :■■■■■■M■::.:■■■..,..■.:
■■■■■■■M OlGE1110 ir111■■■ N■■■MEN ■■■■■■■ NN
■■.■NMI..■.MEN :..
■NNE■I■■■■■■NH■■■NN■■■
NONE ■M No ■■■■■N
:::::I::::::�PENSION:::
M •••••••
O No
M■■■.I
■■■■M■NO■■11NN�LMON NONE MEMO
N■■■■
NOMMN ■a ..■.. ■■■MEN
■■■■MI:■M■■■MUM
MEN, MEN
fill =.&I"MR171
Agent or Applicant Printed Name
Sign [pre "Please read compliance statement on back of permit"
l
Aep ication Fee(s) Check #

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit; ^I,t, ,� A Luzy-,U�t "
Mailing Address:
Lt2- 1LL.iJ_ 11 (c� x'
Phone Number: ---
Email Address: i7 r ♦q, {- r ra.>aA.,,; I ±- L ";
I certify that I have authorized
Agent J Gvntractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development 1i117 (Q elC ! Ea—}i 1� 1
nr 1C Qlan)(Arp' w i �k Np.L.) Ar)ck a ^ �. kn rk1 [_s �tt
at my property located at
in ! �En r, t County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information rt?Iated to this
permit application.
Property Owner Information:
:-72 t
signature
Print or type Narne
TWO
Uate
This certification is valid through I___

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner ji l" y ��r� en t7 tI
� ,11
Address of Property. Jon i' > r7 l tr'li ^�>�J i�1'L/tr
(Lot or Street b. Street or Road, C.ty & Coun:y)
Agent's Name AtQI� � nit t, Moiling Address:?— L 4'1S bed -+
Agent's phone #: _( lb 1' ct ..'r.3 ;- Ij`? �.{> G��SC711V I ���T �i t -2-b-511 is
I hereby certify that I own property adjacent to the above referenced prooerty. The individual
applying for this permit has descrfbed to me as shown on the attached drawing the deve'opment
they are proposing. A d"e rip6nn or drawirn with dlmensiQns trust be orov,ded with this letter.
y 1
i have no objection, to this prapos;d. _ ., -I have objttclions h> this proposal
r
N you have obloeflons to what is befngproposnd you must notify fhe Division of Coastal Management (DCM) in
wdttng within 10 days of roocipt of this .notice,, Correspondence, should bo mailed to 177 Cardinal Drive Ext.,
Witmfngfon, NC, 28405.3845, DCM representommN can arso bo confacted of [phone]. No response is
considered the same as no objectloa N you have been notified by Cortifled Maff.
WAIVER SECTION
I undorstand that a pier, dock, mooring pilings, brookwater, boathouse, IA, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived oy me. (if you
wish to waive the setboc<, ya. must Initial the appropriate bank below.)
'�' v i. - I do wish to waive the 15' setback roquiromant.
I do not wish to waive the 15' setback requirement.
(Property Ownor Information) (Adjacenttperty Owner
•S't t!rtrtlltrr? . rrVVll ,
print or Type Name
ks' kTrtr-Ir.4 -.LL
Mailing Address
' swe{lu )A/ bar f,C.l
9 i y) i-;Me-r,.27,5H
Telephone Number
/''S f ray 4,t /� % �' /� • ,/ /� -T� ;✓ -S.
pdtit or Type Name
Marling Address
Coy/tote/Zip
Telephone .Number
Date
Revised 61IM012

CERTIFIED MAIL. • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: E "` / r
Address of Property:
(Lot cr Sttrreet#, Sueetbr Road, Cirf b CC nif) l
Agent's Name #. f`� 1 CAC �N t I N DT I Mailing Address. Z7 i 1 Z1 S
Agent's phone# �iiD-33D 55�t� Cr~rek- ►2d. �c,�ks�>r�uitl Inc,
I hereby certify that I own properly 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, P descrption o' drawing, with dimensions must be provided with this letter.
5( I have no objections to this proposal I have objuWuas to this proposal.
I
If you have objections to what Is befngproposed, you must notffy the Division of LOistal Management (CCU) In
writing within 10 days of receipt of this notice. Corraspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 28405-3845. DC.M representatives can atso be contacted at (9% 796.7215. No response is
considered the same as no ob ectlon if you have bean notified bg Cert ed Mail.
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, yot. must Initial the appropriate blank below.)
M A l� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback reclii errent
(Property Owner Information)
!j ..v' 7 1
rgnc e /
f"/nry �'LArFL1/9I
Print or Type Name
Malting Address
T
o4mat�r' p
Telephone Number
Date
(Adja nt PropOwner Information)
Sig) iure�
Print or Type Name
,lRl�trti�N�
Mailing Adore
City/Statelzin
Telephone Number
Date
Revised 6/t& WI2

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner
Address of Properly:
(Lod cr Street #. Streetor Road. Cirf 6 y
GJJ
Agent's Name #: �A�) -� tGN O N Dr') Mailing Address 7 q y 14 A �� S}
Agent's phone#: °iiD 33L7jrjli�t1�- rZ.C{- �C�KSG;VI�,I NC'
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permi' has described to me as shown on the attached dravring the development
they are proposing. F descrotion o- dravAng, with dimensions must be provided with this lottor.
5 &__ I have no objections to this proposal. _._ I have abje4tium to this prurusal.
have objections to what Is being proposed, you must notify the Divistan of Coastal Management (LCM) to
7 within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ert,
igton, NC, 28405-3845. DC,N reprosentatives can arso be contacted at 1`910,- 796.7215, 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 Y riparian access unless waived by me. (If you
wish to waive the setback, yot. must initial the appropriate blank below.)
A P I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Property Owner Information)
xgnarare V
t�Pnre /�• (23444L12C����-
Print or Tyne Name
Mallfng Address r
City/Sfate/dip 7—
Telephone Number
ate �
pare
or
InformatioW
�n�rtl�i L
C,eL� �s���ul
Telephone Number
Date
Af
II gol9
Revised 6/1WO1

I
5
o �
7, OOo !h5
G bo�fil.;fir
N. Draw" 1, Yo► 1,.
z

©
/1
o
w
0
O
CQ �
m
v "
,t
r'
I
r`
�.. ta-..silo--•` � 4�
.en..
rf�-�"
,z.
1
t
f
tea
11 1
for.-
t
s\ y f
a ,
r
`* ` � O� l � A� ♦ � t �;j lr(q�
i 1
" rq
a
�q� iY ,
r"5 ,4 n
Q �2y 1, •
�• ``z' � � / y. y`i �" g. ,eft` Y�i j,