67238D - Adams

1CAMA / ❑ DREDGE & FILL
IENERAL PERMIT % a �(�
New ❑Modification El Complete Reissu ❑ rtial Reissue
ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
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E-Mail�
ad Agenti-0- tiU MQM-.2- I �9 C,i'bt G©si•
❑ CW
*W )�TA ❑ ES ❑ PTS
❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no
PNA yes / no
Project/ Activity
:k)length
itform(s)
Platform(s)
er(s) I tP f
4
igth
nber
i/ Riprap length
distance offshore
x distance offshor
annel
iic yards
ip
se/ Boatl
v
Length V v
not sure yes no
ium: n/a yes
y no
\ttajc(h�eQd::� yes , no
S e' rmit)n be requiredJby:
Local Planning jurisdiction) A s s
A B
Previous permit #
Date previous permit issued
`i
❑ Rules attached.
Project Location: County & �A S O �i V
Street Address/ State Road/ Lot #(s)
� t)�
Subdivision
city t`ax i IG ZIP
Phone # O River Basin
Adj. Wtr. Body nat r
Closest Maj. Wtr. Body
❑ See note on back regarding River Basin n

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 1 Vr Permit* �
Date:C J�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied. for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other ,
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Name of Individual Applying For Permit: 6 e- EN N /Zp,s
Address of Property: / 90 �z !!�- y T 7)81 L/
(Lot or Street #, Street or Road) .
(City and County)
I hereby certify that I own property adjacent to the above -referenced -property. The individi
applying for this permit has described to me as shown on the attached drawing the development tl
are proposing. A description or drawing, with dimensions, should be provided with this letter,
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa;
]vlaaagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu:
set bck a minimum distance of 15' from my area of riparian access - unless waived by me
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.
1 I-L -- 9 - 2 Z

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVERFOR,
Name of Individual Applying For Permit: ( Q n Rog A S'
Address of Property: 2 E Yar,h
(Lot or Street #, Street or Road) .
(City and County)
I hereby certify that I own property adjacent.to the above-reference(L.property. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lettc
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395.
within 10 days of receipt of this notice. No response is considered the same as no object
you have been notified by Certified Mail.
WAIVERSECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift m
set bck a minimum distance of 15' from my area of riparian access - unless waived by n
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.
f - 2 f- /C.
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