66614D - Dowless

}LAMA / ❑DREDGE &FILL 4,--
666'
A B
Fz�ENERAL PERMIT 10 / Previous permit #
ki ew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
nt Name I " G t J(��l Project Location: County i
s �Z� ��'�s� t Street Address/ State Road/ Lot #(s)
1%r'1l State ZIP
# (�) 5 �Z -mil % `� / E_Mail Subdivisipn W U6-�—
ized Agent N,
d ❑ CW 3VW ❑ PTA /�MS ❑ PTS
❑ OEA • El HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes) no
A Project/ Activity
ock) length
'latform(s)
length \�
uniber
ad/.A]prap length 7
vg distance offshore
iax distance offshore
channel
u�c yards
trnp
)use/ Btiatlift
Bulldozing
ne Length im
not sure yes nb
- 7 T
)rium: n/a yes And
yes
Attached: yes
ling permit may be required by:
Local Planning jurisdiction)
City 0ZIP
Phone # ( �4— River Basin
Adj. Wtr. Body 4 / W A)
Closest Maj. Wtr. Body
(Scale:
i
� f 14/ (µ ��f ❑ See note on back regarding River Basin

NC Division of GOasfal .Mqt. Habitat lrnpact GOltt�pUtei' Sheet
Applicant:
Date: b — 1 P b
Describe below the HABITAT disturbances for the application.
Habitat code sheet.
All values should match the name, and units of measurement found in your
FINAL Sq.
Feet
FIN.
TOTAL Sq: Ft.
(Applied for.
(Anticipated final
A lied for.
Disturbance
Ant
dish
Disturbance.totai
DISTURB TYPE includes any
disturbance.
Excludes any
total includes
any anticipated
Exc
rest
Habitat Name Choose One anticipated
restoration
and/or temp
restoration or
.
restoration or
tem impacts)
im act amount
tem im acts
m
am
��
Dredge ❑ Fill ❑ Both Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑. Fill ❑ Both ❑ Othar ❑
Dredge 0 Fill ❑ Both ❑ Other El

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: M 16 046 L Lv . JOW Lti S S Sk
Mailing address: S- l- L S.q-1_ j C Gd+e 4P
14)1L141/N6ZD41 /L,>C ZIsYt/
Phone Number: (?10 S-1 Z 51
I certify that I have authorized SELF
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of k it WALL /11UL'e-# -
c
E OL Al vli- i
at my property located at LOT 5 2 q 2 3 3 3.8 ,P8 S-%y 2 SyCjG RoW13ae SLC
in 1 19r-- A,,9 �t2 County.
This certification is valid through
(Property Owner Information)
Signature
✓ /' 116 AA-1 Z k1l Ak& 1 SS 541�1
Print or Type Name
Date
Title
c--i_../

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
1= L
W ,
6ol.,U
' =
Address of Property: !
o S .Z, 0'
6, 3 4
-t 313
1 61
�fy 7 541,/& i4,+12d0rp SGL � 11
(Lot or Street #', Street or Road, City & County)
Agent's Name #: 51ZLF,Mailing Address: `� 12 i 5AL71 a DA,;� I)W
Agent's phone #: % / U - Z `i ) Ll l Lv i L-VVI , ti - L , ? t /
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
/V /G1,f L 1-v - /JOtvt
Print or Type Name
(AAacent Property Owner Information)
S gnature
2j "O LL )q. I&OtJE-
Print or Type Name
44
Mailing Address
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to rjS Soe $s
(Name of Property Owner)
property located at e Z 3 4--r: ;6 s v;.�, i-fAA3oA .&/ j9s. 4Lj
(Address, Lot, Block, Road; etc.)
on 'UPSaiL 5v %vein H-AM1157G.f0 pe t,6%l` N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loc
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 drawn
RLPL4LE►1ENT OF 15)((S1-+iv�, /L*ri{INW/Livf LvL-LL
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set t
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
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
/;1 /G 94 (-; L 4-cl , -%Ow[ d 55
(A acent Pro ry ne In rmation)
X (0c
-
ture
ESQ <�_
Print or Type Name
Print or Type Name

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VIEW FROM SID-
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Erosion Escarpment
Soldier Pile Si+etlh4nef
Bolt
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Normal High Water
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Normal
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Indication and important Safety Information
Indication
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a Iwrmone-mieasatg lUD mat prevents pr�gnanc •• fcr
up to 3 years.
Important Safety Information
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or nave �". M ::ance (Joni use Skvla. Less roan
FULL PRESCRIBING INFORMATION
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Giam108"if'"'
Wilmington
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NORTH CAROLINA
FENDER COUNTY
1, L SCOTT BAGGIE, CERTIFY THAT THIS PLAN WAS DRAWN LOADER MY
SUPERVISION FROM AN ACTUAL SURVEY MADE UNDER NY SUPERVISIIM, \
DESCRIPTION RECORDED DEED BOOK 41M PAGE 139 .
PLOTTED FROM INFORw1TION REFERENCED.GSAM
THAT THIS PLAT WAS NOT \
PREPARED IN ACCQlDMICE VITA . M7-30 AS ENDED. WITNESS
MY ORIGINAL SIGNATURE, REGISTRATION NUMBER AND SEAL THIS \
BTH DAY OF SEPTE!! ER_-, AA, 20 T5 -_ .
71TTCUNAME, P.L.S \
REGISTRATION AMBER L-3450
"7_
"Mdu^;aaxu
/ YY
/ O
rI
/ / \ 'C \ m
C) \ \ \ \
w � \
�: ✓ \ 13,6 sq. ft.
0.31 a res
8 4A
ti014 SE NN oLD HEAD
4 _'—HIGHATER LINE \ \ l
/
\ y
TOTAL AREA `\ l
25,677 sq. ft. \ MA"jZSH \ \ l
0.59 acres \ \ \ l
SITE
r�G
VICINITY MAP
LEGEND:
\
R/W — RIGHT OF WAY
BFE — BASE FLO6D ELEVATION
\
HIGH WATER FLAG
A WETLAND FLAG
\
O CONCRETE MONUMENT
\
I
/� \\
\
\ \
WETLANDS LINE TABLE
LINE
LENGTH
BEARING
L5
18.87
S20.37'09'W
L7
28.29
S17.19'12'W
L8
.15,93
S18'18'04'W
L9
26.59
S34.51'55'W
L10
45.38
S38'29'04'W
\ r \
ro \ r \
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