66633D - David

CAMA / C DREDGE & FILL `� V
�II l _ A B
"ENERAL PERMIT {� Previous permit #
<New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources ^-7O
Zoastal Resources Commission in an area of environmental concern pursuant to I SA NCAC U I
l ` O Rules attached.
it Name
nCi S� a� I C�- Project Location: County
Street Address/ State Road/ Lot #(s)
State N � ZIP � loq !' �VYC i 16i 6-
E-Mail
(-�- Subdivision
:ed Agent
❑ CW �EW J_PTA ❑ ES ElPTS
ElOEA ❑ HHF /❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes
f Project/ Activity
,ck) length
atform(s)
Platform(s) -0 x
;ngth
mber
d/ Riprap length
g distance offs c
ix distance sh
cannel
bic
Boatlift
ulldozing
1
Cityn 6 aV1 -1 k (�'ra ( (n ZIPS
Phone # ( ;I 6L River Basin G('W
Adj. Wtr. Body 1!\ (nat /
Closest Maj. Wtr. Body 1AA/_
h F--k-O ,'V—
(Scale:
rim
❑ See note on back regarding River Basin r

_ NC Division of Coastal Mgt. Habitat Impact Comp
Applicant:
Date: 0 (Q (01 I , v < <.
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
FIN
(Applied for.
(Anticipated final
(Applied for.
(Anl
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disc
Habitat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Exc
rest
restoration or
and/or temp
restoration or
tem
temp impacts)
impact amount)
temp impacts)
am(
Dredge ElFill ❑ Both ElOther a
C�'
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 ❑

■ 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:
,r"
r2c. 3
A. Signature
X 1 ] ❑ Agent
G.J ❑ Addressee
B. Received by (Printed Name) C.
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
II
i
N�III
IIII
III
I I II
III
I I
I
I I
II
III
❑ Adult Signature
❑Registered MaiIT"'
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certified Mail&
Delivery
9cnn nAno i IF4 5285 7683 62
El Certified Mail Restricted Delivery
❑ Return Receipt for
0 6 9?- 9009 E 0 0
2. Artie }1 9 0
I r`.,n—r nn Delivery
Restricted Delivery
S r[ Q
Merchandise
Signature ConfirmationT"'
._..._ _. ,
❑ Signature Confirmation
O Insured mau nu—Aed Delivery
Restricted Delivery
(over $500)
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(TOR A PIER/MOORING PILINGSBOATLIFTBOAfH�OUSE)
I hereby certify that I own property adjacent to re S f V ONy d `s
(Name of Property Owner)
property located at NCk r'1 C,-) G S -i-
(Lot, Block, Road, etc.)
on CGna 1 ,in U(ecn 3Sle GeGCli ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: U S- 486Mailing Address: PU (; 0 `X 1 � 3 -)
a ecv, 131e , N L 2 8 465
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (IY) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
a —
below.)
I do not wish to waive I
I do wish to waive that setback requirement. `K
1--------------------------------------- ---------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DtVELOPMI NT:
(To be filled in by individual proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
3
•---------------------------------------------------
(Riparian Property, Owner Information)
Mailing Address
ignature
U ( eC-„ Zsie t3e�c ,v c 28y69 D Ai- / ),r)q ZA Ors Z 2 'r-

6-07-'16 11:47 FROM- Sloane Realty 01E 910-5?�+-F✓?1 T-Q
POW /0001 F-666
W'V . ' 9F C OXSTAL MANAGEMENT
A.DJACK?4TAOA; d t PZ p1'ERTY Q R STATEMENT
Name of Property Uw,zer: ,h--)( -5 . � �V 1
Address of Property: �? (N�C-kry)cnc) - 4- '( c�n -`7S 1 e_, /ifC:..
{ (Lot or Street #, Street or road, City & County)
ApplIcant's phot►e #:_ `C � r 3 L f )^ . 48� Mailing Address: PC) 13o / '] S S
l hereby certify that I own property adjacent to the above referenced property. The individual applying for this pormit
ias described to me as shown on the attached drawing the, development they are proposing. A descr. i ion of drawing„
s'iit di e 'have
be wovided with this letter.
}rave no objections to this proposal.- 1 have objections to this proposal,
IfYou have objections to what is bebag proposed, you must notify the Division of Coastal Management (DCM)
in writing -svithia 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Est,
Wilmington, NC 28405-38,45. ACM representatives c tm also be contacted at [phone]. No response is
mmidered the.sAme as pe q&ction if you have bee1#otif1etl by_ ertirted Mi il..
WAIVE& SECTION
( understand that'a.pier, duck, mcwring pijit)gs, breakwater,baathnusq,.3r lift must beset i_tack a minimum distance of
15' from my area of riparian access unless waived by tiro. (1flrou wish to waive the setback, you must initial the
appropriate blank below.) /
1 do wish to waive the 15' set back requirement. ri r j c, t �t e r' e�_��
_ I do not wish to waive the 1S' set back requimment.
,Property [Owner Information)
Signature 3�
Print or Type Name
f r, 13 c;x 1 g 3 �
�tifailing Address
City I state I Zip
(Fipari[ ut Property Owner futorntation) --- -
S'
ego re
Pnnt or Type Naine
Mailiog Address `- - —
City /State 1 ?ip
r', ,1 1 1 /L- --IIr i