66634D - Cassese

VAMA / ❑ DREDGE & FILL
'ENERAL PERMIT Previous permit# #ew ❑ Modification El Complete Reissue El Partial Reissue Date previous permit issued
'zed by the State of North Carolina, Department of Environment and Natural Resources a
.oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC n�
� El Rules attar ed.
t Name Q,v\ S�e S-G Project Location: County LV,
Street Address/ State Road/ Lot #(s)
`j A VV\ State kl r `
(MO) ; t 3�E-M( -ail /� / Subdivision --'
adAgent �\�uV � `1 `a -a 6y dr'bo L �� City ZIP
❑ CVN ,>gEW [PTA ❑ ES ❑ PTS Phone # () River Basin -VV
❑ OEA / ❑ `HHF T❑ 1H ❑ UBA ❑ N/A i A /
❑ PWS:
yes /(no PNA yes /
Project/ Activity
FV
A) length
tform(s)
'latform(s)
igth _
nber
I/ Riprap le
distance c
c distant
annel
is ds
e/ Boatlift
Ildozing
Length
not sure yes o
im: n/a yes o
yes no
ttached: yes no
Adj. Wtr. Bod Mat Ir
Closest Maj. Wtr. Body
�Sh Id h`n
1 (Scale: �I
g permit may be required by: �f Y ` (�t ��{jV1 (�t{ ❑ See note on back regarding River Basin i
oral Planning Jurisdiction) r
. — .... 0, 'l i c .—, 1 t ►1 ..�. �, ►„ 1 -1 I ,. Lt

NC Division of Coastal Mgt. Habitat Impact Come
Applicant: kvq-'`
Date: p(e
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
(At
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex,
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ter
ternimpacts)
impact amount)
temp impacts)
arc
O
Dredge ❑ Fill ❑ Both ❑ Other
01
t
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

KMA
NCDFWR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue ,lames H. GmTson Dee Fi
Governor Director SE
AGENT AUTHORIZATION FORM
Date:
lame of Property Owner Applying for Permit: NameofAuthorized Agent for this project:
C C�SSeSg— KI, Il �rol�le►
)wner's Mailing Address:
C,a gqi�
Agent's Mailing Address:
'hone Number W) 12 `:a.- J L] % Phone Number D63X5
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or constnict the following (activity):
my property located) at 334 IV6 r S 5
this certification is valid thru (date) 7--� fO

...- 'C" N'rie,>4
CER'I`D k-YIA Ii, - i2FTLTRN RECEIPT RE pSTED
DiiSI01` of Ca �.S TAL lyL4�AGENiEti'T
ADJACENT 1UPART-AN PROPERTY OWNER STATET'MI NI T
I hereby cee6fy that I own property adjacent to
ro located at {� dame of Property Owner)
property 3'-1' �� t3 Ir ,; t- t: : _
on (Lot'
in
etc.)
(Y4aterbody} N.C_
(Town and/or County}
A.pplicant's phone # _� ! ,��5 - h `7 `�- Maiag Address. _,
LaCAA i t t�
He/Slte has described to me as shown below the development helshe is proposes at that cation,
and I have no objections to the proposal.
D ''SCRUMOIN AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Xrcdividual proposing deveIOP Ment must f U in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Niaaa ement
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive EA Wilmingtooa� DCM representatives can also be contacted at (9I0) 796-7215_
Nor arse is considered the same as no ob eeion if ou have been notified b Certified Matt
f�F e Information)
Signature + '
of
Print or Type Name^�'
Mailing Address
(Ri arian Property er I rmation)
Sigtmiure
Print or Type Name
'
Mailing
M.ailing dresses /-
lA, �,J r_r, %<" , , /

Ems•.! NrNeO4
r• ■r t i � r • • • r r f► s r
DIVISION OF CO 4STAL NLkN.A.GRMMNT
ADJACENT RIPARIAN PROPERTY OWNER STATE-,MSNT
I hereby certify drat I own property adjacent to �-�-5e.„,�•y�, �� a C�, � ,
property located at
(xXame of Property Owner)
� � �) /j/� Q �� t; �,
(Lob Bigqck, Rpad, etc.
an 1n% , in
��i �Y-, i r C,�,
(Waterbody) (Town and/or County)
Applicant's phone #:C111 0 - _g 01 5 �{ '7 M Address:
�.
He/She has described to me as shown below the development he/she is proposing fit that Ioaation,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIYffNT:
(Xndividual proposing development must fdl in description below or attach a site dray
7Tc-'
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Ben Baker Geneveive Cassese Jerry Tod(
n!O A Lill.