69033D - Barnes

JNCAIVIA/ '❑ DREDGE & FILL
PENERAL PERMIT
ew `Modification ❑Complete Reissue
Q�3.�G.IrI A B C D
Previous permit #
❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources /� t1 r
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC C 1 , _2�0O0
Da
�J,� A El Rules attached.
Applicant-Namea nl I �/1 1? t aLe s Project Location: County Ne i y
Address 1 1[y 2�` VU (� [ ()(�Y �{�V Street Address/ State Road/ Lot #(s)yLjf ji1�(%(J�S(C( rlt
City 141 i l�yt (� ?iV1 State ZIP 2 fi11y�
Phone # (°�i (� L�p� q P7 E-Mail ` f �p Subdivision
Authorized Agent N to C 4+1 City �V I M jA G1 V h ZIP 2Pq 09
Affected ❑ CW
EW lA PTA El ES PTS
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Phone # ( )
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�.nt or Applicant Printed Name
Signature "Please read compliance statement on back of permit
201)`" -11C'- 3
Application Fee(s) Check #

NC Division of Coastal Mgt, Habitat Impact COMP Ater greet
Applicant: �J�n(/�
I�jGi,� YI,�S Permit #: �033
Date:
Describe -below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet. FINAL Fed
DISTURB TYPE
Habitat Name Choose One
ow
Dredge ❑
Fill ❑
Both [I
Other
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Dredge ❑
Fill ❑
Fill E]
Both ❑
Both ❑
Other ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Dredge ❑
Dredge ❑
Dredge ❑
Dredge ❑
Dredge ❑
Dredge ❑
Dredge ❑
Flit ❑
Fill ❑
Fill ❑
Fill ❑
Fill ❑
Fill ❑
Fill ❑
Fill ❑
Both ❑
Both ❑
Both ❑
Both ❑
Both ❑
Both ❑
Both ❑
Both ❑
Other ❑
Other ❑
Other ❑
Other ❑
Other ❑
Other ❑
Other ❑
Other ❑
TOTAL Sq. Ft,
FINAL Sq. Ft.
TOTAL Feet
for.
P final
(Antici cited
(Applied for.
Disturbance total
(An$lpated final
diiutance.
(Applied
Disturbance
disturbanca-
Excludes any
includes any .
Exdudes any
total includes
any anticipated
restoration and/or
anticipated
restotation or
restoration _
and/ortemp
restoration or
temp impacts
temp impact
amount)
temp impacts)
im arnount)

Date
Date
Check From
Name of
Vendor
Check
Check
Permit
Receipt #
Received
Deposited
(Name)
Permit Holder
Number
amount
Number/
Comments
Wells
David & Jennifer Fargo
3/14/2017 Barnes same Bank
7153 $200.00 GP 69033D BS rct. 3754D

■ Complete items 1;3 enc1-.
■ Print your hame aril address.pn the.reverse
so that we can retC ftff 4cal'd'to �du.
■ Attach this card to,1twb4pItpf the mailpiece,
or on the front if space permits.
Article Addressed to:
�1 l bt l � is I�� 01�lc, v6A
J i I ( M(ANf r1k
W',)k 2�q b`j
11111111111111111111111111111111111111111111111
9590 9402 2653 6336 5191 15
n.+;..m Ni imhor ffransfer from service label)
7016 0600 0000 8212 7545
• PS Form 3811, July 2015 PSN 7530-02-000-9053
■ Completgitems 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 too:
�UL V►`"WL
A. Signatl� js
X ❑ tt
ALti' ddressee
J (--"
B. Receivv b Pri' e) C. Da a of Delivery
D. Is delivery address different from item 1? ❑ Ye:
If YES, enter delivOi F d tow: ❑ No
DCM WILMINGTON, NO
IVIHK 13 2017
3. Service Type
❑ Priority Mall Express®
❑ Adult Signature
❑ Registered MailT"'
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certified Mail(D
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
❑ Signature ConfrmatlonTTM
n 1—ured Mail
❑ Signature Confirmation
ured Mall Restricted Delivery
Restricted Delivery
ar $500)
Domestic Return Receipt
A. Signature
X (0 Agent
❑ Addressee
Receive (Printed lya ) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
I IIIII III III I IIIII I I II III I I I III (III
9590 9402 2376 6249 7367 02
7 U 16 2 71 0000 0 5 21 8 5 7 2
_
3. Service Type ❑ Priority Mall Express®
❑ Adult Signature ❑Registered MaiITM
❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted
ElCertified Mall Restricted Delivery ❑ Rat Receipt for
act on Delivery Merchandise
act on Delivery Restricted Delivery ❑ Signature Confirmation'
ed Mail ❑ Signature Confirmation
I❑ Insured Mail Restricted Delivery Restricted Delivery
(over $500)
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: �0.v►yt
Address of Property: �Lq4 �Oo �•� '"�
(Lot or Street #, Street or Road, City & C unty)
Agent's Name #: NA Mailing Address:
Agent's phone #: NA �1� %C 22q �
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 whet Is being proposed, you must notify the Division of coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified 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, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
5 �M I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Print or Type Name
(-yd-A wf* 4 '0 �► wt_
Mailing Address
l)}vm , Iy c- 2,PYo q
Clly/SMM2ip
9 1d - sou q, 4k < -7
Telephone Number
Z z�
Date
(Adjacent Property Owner Information)
Signatuur�e
- Y10\ yW\ MO-uYe—
Print or Type Name
"o K4 �t �-
Mailing Address
W,LW,�- M- ZEY11i
City/StatelZip
q to - ypq - �;13
Telephone Number
3jo
Date 0q 1
Revise 6/1 K012

DE
n I :Z/I()I)l
J
r
U) �JC, 2 D
3
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y nu _ cyy\
_639-1 .
RECEIVED
DCM WILM►NGTON, NC
_

0
E
3 Np'\" Borg UrFTS
0
0
0
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lk'
b �
1
ham 4\k- , Q"V\ a - , ,;.� vJ�a, d � �►1l g�
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vwq � h�9�� al-t-m1��' 1�11\
' �CI r
DCM WILMINGTON, NC
1 IAAR i 3 2017

ADJACENT RIPARIAN PROPERTY, pOWNER STATEMENT
I hereby certify that I own property adjacent to IUL,`haw" J s
(Name of Property Owner)
property located at 52-` 4 WOOW► C
(Address, Lot, Block, ad, etc.)
on L Cw , in m, N.C.
(Waterbody) (Chyffown and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
)�s ra,...)1 4 ds;�t-4
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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
S�gnature
Print or Type Name
Maifirkq Address PC— 7- O
City/State ip
q ► o - vv g - (4<L,-)
Telephone Number
Date
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
RECEIVED
Date E)CINGTON, NC
(Reviseft1 rj*4J%7

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: �" 1!S0.v►yJ
Address of Property:
1;LgLt
(Lot or Street #,
Agent's Name #: N A Mailing Address: L --*,Uk h4 6,—
Agent's phone #. NA `A11 , )IC �pq 01
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
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified 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, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
\Signature
Print or Type Name
&fa a bve* 4 �YIwA-
Mailing Address
City/Stahe zip
Ord - `'()+ 4s&-
Telephone Number
2l �3l
Dart
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatelZip
-
EC
Telephone Number 'EI 7
GCM WILMINGiON, NC
MAR 13 2017
Date
Revised 611812012