66273D - Fullbright

�CAMA / ❑ DREDGE & FILL
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ZENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
>rized 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 n
Rules attached.
itName Project Location: County �V
I,i .� ,L f.
{
\% , ✓ ') { t1� ._..� 1 V Street Address/ State Road/ Lot #(s)
State NC ZIP �kk
E-Mail Subdivision
Eed Agent c iid•ty f,1 Ma fi' ry City�� �1.� J ZIP
❑ CW XEW PTA ElES ❑ PTS Phone # ( ) 1 l] River Basin
❑
OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ Pws. Adj. Wtr. Body ilf � m%{�`-- ��V ✓ nat
yes I no PNA yes X no
Closest Maj. Wtr. Body a
(Scale:

MC DiVisaon of Coastal PIgt, -Habitat Impact Computer Sheet
kpplicant: C�i✓ � J v `L,0C, lAx Permit #.
)ate:
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
labitat 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
l
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge R. 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 ❑
1 1 f\

��A
NCDENR
North Carolina Department of Environment and
Division of Coastal Management
it McCrory Braxton C. Davis
governor Director
Natural Resources
AGENT AUTHORIZATION FORM
Date: 3 /3 1(,
John E. Skvarla, II
Secretary
�ne of Property Owner Applying for Permit: Name of Authorized Agent for this project:
ner's Mailing Address:
� 2 Qi0UNle,3 -Dr.
40. -A . AC- 216y6'1
me Number ( Ito) 6rI7- 76y 7
Agent's Mailing Address:
►1 w�,,,�,�� . PC- Zgy l l
Phone Number (410 ) 262 6°I9eZ
'110 619 036Z
�rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at Q Z Pr. Le-&Aa , W— 2 fSyS
certification is valid thru (date) 6-1 1 S/16
3 3 (o
' nature Pr perty Owner SDate

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: !::7 1►Za v („ -7: �&t^,,�,
Address of Property: IZZ �Je(s�;e�J $�,� %L
(Lot or Street #, Street or Road, City & County)
Agent's Name #: �� Jav��S _ -Mailing Address: may _
Agent's phone #: _ q IQ Z62 61cl-,5
`Ito 61ck o36Z
1 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.
G� 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. DCA1 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.
''"�,
tlnk� �� 1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sigiebture
Print or Type Name
i-ZZ. Cioe.4l l uJ
Mailing Address
(Adjacent Property Owner Information)
Si attire
Print or Type Name
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 'j; L. L— s
(Name of Property Owner
property located at 0 ZZ 9-0t"o; eo -0r Le-6-Ad— N c— 2 ogS 1
i
on �,� (Address, Lot, B1lo�k, Road, etc.) ce. t"„,� in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locat
NERE 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 drawing
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bac
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w<
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
(Adjacent Property Owner Information)
lure
SiSig
Si nature
Print or Tye Name Print or Type Name / �

From: 2025447696 Page: 112 Date: 3/3/2016 3 47 11 PM
1 ti ! • ♦♦ C d
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I otpctr bpi OlttW Ermbeth, L. Fuibright
Mdhs of Properly: 1-22 Riverview Drive Leland NC 28451
p,,ot_arftntf, Suess or Road, CRY & CmM)
Ap nrs Nui it Jack J©nes Wetg Addrtow;
ens'eP # 9to 262 6qq� �;1►M�h��� .�C_
qla 6tq o3L2 �� V
1 hweby *w* grt: l"'aan prop" s* cerd to the above redenanoed pmperty. the Wdvidud
appbhq tar fi4ls p n* foss detatW to me as shown, on Me seadlsd &MACA18 deve+ Mw"
fhW we po"ft A
lWW-
on= objections to this propu=L 1 have objectiaas to this proposal.
+rawr�a *+���arn+��4 fo..l.scnsAly ta. avism dc+o�MlitifrtrrpsMl�rat Qx'�4 sr
.� irk ar�at�r.rrart. a•drte, .�,1,rlrtipowdna. ahoar;i+aalid� 1s1' Marti. �
M i MC, 29009.r &OW can WW be cwe.allAa! � 7�-r�►�C �O �.p«>r. k
WAIM SECTION
t WxWvWnd that s pW. dock, ntoodlp p4 ps, br+aekr vlw, boa www, it or groin must be set
lade a r w*mrn die bwvw of IV h+am fny arose of dp"n aooesa ur*Dw weivsd by rrW (►f ym
Nihh to wawa, *w set e&, you am" ff m appttvp We bWj* below-)
tddlll * ID waive fhe 15 aelbst* req*elnent
1 do ti * %Oh to waive fie 1 s 80030p k requtmmenc.
Elizabeth L. Fulhnpg t
PrM Fr Type Nance
122 Riverview Drive
�p
.[:, wW NC ZU51
9tOR27647
T�YlrwarlMr _ _
ase sign at
tliriirlp lldiirses
202 3S2 -2- `i

From: 2025447696 Page: 2/2 Date: 3/3/2016 3:47:12 PM
t�EdCR�"i'I�IIM AMA 1l'llgMfil �iF P'��
O propoalft piN l�witrf i/ i-6iloMts apba�i �1a
1 ur and 8 ~I Ws*d as 4 poaMuw g► wWohWAtosd back a
min rmm di jj j ' ;e IW lifw w my ow of riwion xx uai+ s wai+Nid !i 7►ou'iwidK to waive
the you, owst'u" ie SW'oprblank bekvtv:).
sign and
1-�icr=ao#�f�r1►� w�rw �r #3fE

11
Y�E
F3s.7z 4
Boat Lift 25' from
126 Riverview Dr.
pro ert line
Boat Lift Locatior:
12'6" x 1 2'6"
,sed Floating
32' lenath
Dock Edge 30' from
122 Riverview Dr.
property line
126 Riverview Dr.
111 Rivvrvirw Dr ! 12n Riverview Dr_

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