68539D - Carros

*AMA / __ DREDGE & FILL /?A 5
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GENERAL PERMIT Previous permit
clew [-]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources i`11
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0-7r, . ON 00
❑ Rules attached.
Applicant Name J {���i(� 1 `� }t ( 4- Ca Y r S Project Location: County 64(14!�A/ j
Address �( ��r L1�) 00
City � I��i•n�r-(�k Vc State ULZIPal I Q
Phone # l� 2 007 E-Mail
Authorized Agent kDy/)
Affected ❑ CW XEW PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ III
ORW: yes //ro) PNA yes /
Street Address/ State Road/ Lot #(s) --
G h� iLr -
Subdivision
Ci SJvl-!k 9 t YI ZIP g�ltp
Phone # (°il��) �i� 0� ver Basin 1.VW1 i'�Cir
Adj. Wtr. Body nat an unkn
Closest Maj. Wtr. Body
r5 WA,INIONNIONIONEINUME
WE
.in length'
number
mmmmmmmmmm= 000110110001 MEN ME
avg distance ofishore HIPLYWARREENEEN moommomm�moomm
- h C4 riUsim. MUNIONE
max distance offshore 0 L 1
t
-NONE
not sure yes
reline Length
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Agent or Applicant Printed N e
Signature * Please read compliance statement on back of permit **
1001 C�b11511ZZ
Application Fee(s) Check #
a rv"G'�f
PermitOffic/er's Pri d N e �
Signature
0`� z� 11olC� 2(� oILC� UIg
Issuing Dat Expi tion Da

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DfVtSK)N OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER N0TW-fCATK)N1"wAfVFH FORM
r Ac " r NW)e o(Prwaty Owne . ... .... C
Adorm of Promdy
ii-oi or stmet st;;;i0f ACAd -,!'y 6 COL, ntyl
Apont' 9 Name 0
;frwi Address: kx"
-let. cwtc
I harm txqtify t1lat I own, to 11he .1b&v0 referamed pmnerty, The irw,4!,w%JU4 applyPg for
the ¢ rrttit tins de&*(kod to me as stows an tne *Wched draw m the develoc4m-f they a
re yopostriq
1-11,1 MEMO
A&
if you have objections to What is being pfop000d, you must notify the Divi3i9f, ot Coestal
HWUPWnsilt MCM) In WHOW within 10 bays of receipt of this notka should be
maRed to f 27 Cardin4al Drive Ext., Wlkwngfon, NC, 28405-3845. DCA# rerresentSM16 cart also be
ro-itacrod at [phone] No resjx-vise is considdrod the same as no objQCtkop *&,h4V* bow,
m tifiod hX CerdWed Moil.
WAWR'SECTION
un4efvtwid that a pi". dfxs ., mwing Pilings, Dreakwater, boattocme, i;,ft, cx grain fmis
't 19-tt DaZA a
minimwn dVam* of 106' trM my area of n: a nar, acoms unlp-ws wai-Vec fly Ire P, yr,4) wkw
selheCk r-)u tn_UqLfqft41 Ow ar wHafe ,ppf
f do wW,, ko wame the Wsatback requiretrQnt
do rwt wish toww". the 15',",tbwk raquimme-it
fp""rty 0wref I"forfriatiow
cap
C
Print 0� Typo i'vem 0
-fit
I - �
~IV Addma
W)acent Pro peo Owner lWor-matio")
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CERTIFIED MAIL - RETURN RECEIPT REgUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Jams C6 c (--�z
Address of Property: ta� �' V3v) j C
(Lot or Street #, Street or oad, City &County)
Agent's Name #: �, �� `-U �p� �Q � g Mailing Address: ` ,.,, ��
Agent's phone #: � b " S � � - � � ��CQS� '� —� 5`'c k �C INC Z INU
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 imgsions must be provided with this letter.
Q 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
Z� Management (DCM) in writing within 10 days of receipt of this notice. Correspot &wi a should be
C mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represenf hv" can also be
contacted at [phone]. No response is considered the same as no objection if yov hikve .been
notified by Certified Mail.
—lam
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, u must initial the appropriate blank below.)
--- I do wish to waive the 15' setback requirement.
L
I do not wish to waive the 15' setback requirement.
(Property arty Owner information)
_ r�Q�V (—� �- � 6-.- Q C�Z r,, �7
Signature
\C ((n S
Print or Type Name
Mailing Address
City/Statelzip
Ln
Telephone Number
Date
f (Adjacent Property Owner Information)
Signature
Aiµ 4 Jam. �•S co
Print or Type Name
Mailing Address
Cit State ip
Telephone Number
--
Date
Revised 611812012

ov %

WIRO
Date Received
Date Deposited Check From (NI/M)
Name of Holder
Vendor
Check Number
amount
permit Number/Comments
Receipt or Refund/Reallocated
9/27/2017
Allied Marine Contractors_ LLC
Derek Rukenbrod First Citizens Bank 5943 $200.00 GP 68517D
SF rCt. 5031D
9/27/2017
Grice Construction
James Mick Carros BB&T 11542 $200.00 GP 68539D
SF rct. 5037D