72780D - Howes

XCAMA / DREDGE & FILL NO. 72780 A B C t
GENERAL PERMIT Previous permit#
'LiXlNew
❑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 H E iJ RY N L-1 w c .5 'ak .
Address
114 NNnso,/ 5ivrr-wr
City RAL EIGis State A/C ziP27&yg
Phone # (T28) 443 • 04.11 E-Mail A1�4\
Authorized Agent 1�1RIcC CoW<T-RLAC T,oA/
Affected ❑ CW XEW )(PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
ORW: yes / >o) PNA e) / no
Project Location: County R Ru A tom,, c IC
Street Address/ State Road/ Lot #(s) ?S 1 3
.5 e>Krr _0Q,vr—
Subdivision
Citysn„/sc- $r�, zip 2y4LLe
57q - 9og5
El ES ❑PTS A&s,fT Phone # (1Io ) ''A River Basin L"Mr-9r• R
❑ UBA ❑ N/A
Adj. Wtr. Body T aTL. E CRE mk nat an /unkn)
Closest Maj. Wtr. Body Al W W
Type of Project/ Activity f C r F L A C'F T) t::> c KI A/ G I - A c I L I T.. I .J
�u 15 1 114 C--, AL 1 c-, (Scale:
Me
oati
Fi
Groi
Bulk
Basin
Boat
Boat
Beac
Shor
SAV:
Mo
Phot
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sure yes
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(nD/a yes no
Waiv_ r_ _ :
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A building permit maybe required by: I O_wAJ �,,F 571a N_f£T j7a� AI4
( Note Local Planning jurisdiction)
PL
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions 0-1 N . 12,0 p N Al j) ALL Q-TM C IZ !CAT-7 J'T" E � t A/ 0
FFDF"1ZAl 2FC[A C ATIet, NC 1A PPtNI
Agent or AppIJ Printed Name
Signature ** Please read compliance statement on back of permit
0200 # 1 z& ►q
Application Fee(s) Check #
71__�-E R. C I.t I9 �
PermitOfficer'sPrinted Name �
Signature
2/14 /2011 G/►4 �201q
Issuing Date Expiration Date

a
i
NCDEWR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvalia, III
Govemor Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM
Date: �>. '/
Name of Property ,, ner ApplyiMo
r Permit:
y z .-
ti r✓ � S
Owner's Mailing Address:
l S � ":-- AV ,,
Phone Number� L�1yC{3
Nam f Authoriizz►ed Agent for thic project:
Agen ' Mailing A ress: //
t�i�7`2 v{ O r1V
� I
Phone Number( q 1
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 follo ing (activity):
r7 `{ S C 1 to C
For my property located at313S U F'Pz
This certification is valid thru (date)
4 Vrope4 Owner Signature
P '4>`'O�
Date
127 Cardinal Drive Ext., Wilmington, NC 2W5
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Oppawmty � Alfinnadre Action Employer

CERTIFIED MAIL - RETURN -RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER_NOTIFICATION/WAIVER FORM
Name of Property Owner: O W AS
Address of Property:
rr (Lot or Street #, Street ol Road, City & County)
- - Agents Name #:1�C iCt GQS`N5VPQ . Ikq Mailing Address:W0 1 dQCh
Agent's phone #: ` ru— S��' 9b9rj n �Q Cy, �� 2--mg
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 rawing the development they are proposing.
6
si I have no objections to this proposal. I have objections to this proposal. A
If you have objections to what Is being proposed, you must notify the Divi ' n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correse should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represents wn also be
• " contacted at [phone]. No -response is considered the same as no objection /%/been
C notified by CertNled Mail. - -
1i 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 -untes-g-waived by me. (If you wish to waive the
n setback, you must initial the appropriate blank below.)
tom- I do wish to waive the 15' setback requirement.
I do-not-wtsh to waive the 15' setback requirement.
(Property Owner Information)
"Y�&
Signature
CAS�n-(-> 1�SS
Print or T)13e Name
Mailing Address
,Y)F� z.�an �q C- - -1 1
City/State p----
�n 44-5-
Telephone Number
°�
Date
(Adja pe>:ty Owner Infor tIon)
Signature
Print or Type Name
Mailing Address
17
City/State/Zip T
%0y-�,-,22-loco -
Telephone Number
10-s/J7-
Date
Revised 611812012

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■ Complete items 1, 2, and 3.
■ 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:
CA tA
A-
X ❑ Agent
(�" /' ❑ Addressee
B. Received by (Pnnte ame) C. Date of Delivery
L! 1
D. Is delivery address ifferent from item 11 ❑ Yes
If YES, enter delivery address below: ❑ No
II IIIIII III I I II II I II I I III II I I II III I I I I I III3. 'Service
PMail
pessO❑ AdultS Signature ❑Regsteed
Mail-
El Adult Signature Restricted Delivery El Registered Mail Restrict
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❑ certified Mail Restricted Delivery ""eturn Receipt for
❑ Collect on Delivery Merchandise
2 Artirla Nirmher (transfer from Service label) ❑ Collect on Delivery Restricted Delivery ❑Signature Confir,nationT^^
7017 0660 0000 7486 8723 '' ❑ Signature confirmation
it Restricted Delivery Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
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Consent for Use of General Permit 7H.1
Lot Number/Address: t -r � Ke: s # --51, E-r
County: Subdivision: N /,A
Criteria:
(check all that apply)
V/Primary Nursery Area.
ter Less than 2.Oft deep.
• Greater than 2.Oft but less than 3.Oft.
x
o Submerged Aquatic Vegetation.
❑ Bottom habitat. `� — ''', Wa-r MA.Jv Chs-r-,u.s rACAI-r-o uNt:QE FtAAT►.J G { ��
poc.V: �s gEt�IG Q�oPoSCv . 5£e- PHo-roJ.
Comments:
Decision:
�d Issue General Permit
o Elevate to Major Permit
ision o-fYvfafine Fisheries Representative
Date
NC Wildlife Resources Commission Representative Date /
Z,
NC Di ' ion of Coas anavement Representative Date
x

Date Received
Date Deposited
Check From Name
Name of Penmt Holder
Vendor
I Check Number
amount
FbrMt NumbenCommenb
Iftw t or Rpun&7?..Necamd
Columnl
Columnt
Column3
CokmuM
Coknnn6
Column6
Column?
CW-4
CokuntlY