66545D Gravatt

.GtAMA,1 ❑ DREDGE & FILL V CX��V 6 5 §1 ; 5 A B
IENERAL PERM IT ' / Previous permit #
New ' ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 0�
} ❑ Rules attached.
Name {-'� ay 6r (�"'►� �y�� P Project Location: County 1` -� 1,l i K
a o" � � Street Address/
�� State Road/ Lot #(s)
�\ V .._ Staw,_ iiIP�'�''1.L LJ Tl �r1 i �L,v'-, s - Sj
do 59 0-3g4_Mail Subdivision
A Agent City I ZIP L
❑ CW ,XWTA ❑ ES ❑ PTS Phone River Basin LyVyL
❑OEA ❑HHF /❑IH ❑USA El N/A I (V ,,A I n I ( k
❑ PWS:no (es / PNA es no
Project/ Activity (: l
t
k) length I
tform(s) I
'latform(s) ILI
igth
fiber
/ Riprap
distance
( distano
annel i
is s
p
illdozing
Im
minu1' 111111,.�'�■■■■LPL'
■■■®■■■■
Adl. Mr. Body -0 0 U
I ( /rClosest Maj. Wtr. Body A l w
ra,�-e
(Scale: I `_
ig permit maybe required by: (OVVA r\J 1 Y��( l� ❑ See note on back regarding River Basin n
_ocal Planning jurisdiction) / i — 1 I I ` � i

NC Division of Coastal Mgt. Habitat Impact Com
Applicant: �/- 6evv'A �4-
Date: dizz-oc - ` /; 01 �
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.
(Ai
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex
anticipated
restoration
any anticipated
re;
restoration or
and/or temp
restoration or
ter
ternimpacts)
im act amount
tem im acts)
arr
owDredge
ElFill ElBoth ❑ Other.
80
8 0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge 0 Fill ❑ Both ❑ Other ❑

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner: Y .
Address of Property: r� f, &,2, iL,: U J
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Ic1Ca�an� ��/,�J Mailing Addressc'�Ll�llr�
Agent's phone #: - V21-),✓s o ILtL (.�✓.�u
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.
(Prop rty caner I or n)
Signature
ICl�l1✓ate l�n�uG�i`�
Print or Type Name
Mailing Address
(Adjacent Property Owner Information)
Signature
�i 4,ZaA 4
Print or Type Name
129-7 A,) L�7r* �7
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �� (��L42�
' r (Name of Property Owner
property located at
II / (Address, Lot, Block, Road, etc.)
on _ lit 04(,)M"p l✓et `Cl t , in L)&)St, )It--rL ov-� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loi
I have no objection to this proposal.
I have objections to this proposal.
uESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawi
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set I
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 Infor a ' n) (Adjacent Property Owner Information)
Signatcz� Signature
Print or Type lyame Print nr TvnA IVamc

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name#: 7to-0/orz--) 0�V24J Mailing Address �Ll�J1�� A&,� zz-
Agent's phone #: IO - 240 - 3970tn V> ,✓sue iLcC� (.�� ,;-c
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' I have no objections to this proposal. I have objections to this ro osal.
p p
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 Ed.,
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.
(Prop rty caner I or n)
Signature /7
Print or Type Name
(Adjacent Property Owner Information)
Signature
Print or Type Name
IYa
Mailina Address Mailinn drlrlracc

■ Complete items 1, 2, and 3.
■ Prin' 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:
(Io4wlza" R✓
jo 7 Nt
O14►6 /SZ
A. Signature
X 17_Agent
�� ❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
g r 14 Z01%
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9590 9403 0424 5163 9658 17
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Merchandise
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PS Form 3811, April 2015 PSN 7530-02-000-9053
Domestic Return Receipt
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Domestic Mail Only
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Certified Mail Fee
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Extra Services & Fees (check box, add tee as ap rophate)
0462
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❑ Return Receipt(hardcopY) $
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❑ Return Receipt (electronic) $ Mal
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Postage $0.49
(18/24/2015
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