67233D _ Kelly

�CAA / DREDGE & FILL
,GENERAL PERMIT ��
Ml� 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
--oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �� - �O�
\_ !! ❑ Rules attached.
�t Name d i Project Location: County V1
G I I My ^-� Street Address/ State Road/ Lot #(s)
cyx}'0, StateZIP3 a 1 4 s/`� • f e",\ f'
E-Mail Subdivision �
:ed Agent _ � 1q o n A (C,ity t�) �.: �1 �1'i�i, Q {'1 ZIP y
ElCW AEW P(PTA ❑ ES ❑ PTS n Yhone # ( ) ' �+� River Basin
❑ OEA ❑ HHF / E11H ❑ URA ❑ WA Adj. Wtr. Body nat
❑ PWS:
vP9 //nn 6 PNO „pc /.fi1 Closest Maj. Wtr. Body
f Project/ Activity
ck) lengthx 14S
atform(s) j
($cafe:
ig permit may be required by: ! UW
Local Planning Jurisdiction)
n ,A
❑ See note on back regarding River Basin rt

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: C-��j�j Permit #:
Date: /
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
FINAL feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount
temp im acts.
amount
%
d 1rl/
Dredge ❑ Fill ❑ Both ❑ Other
A (S
—7 C�
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both �] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Pat McCrory
Govemor
KI,Y
.,AV
I
NCDENR
North Carolina Department of Environment and Natural Resources
N.C. Division of Coastal Management
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date: /D �`� ' � -, 2PlD
Name of Property Owner Applying for Permit: Name ,�Jf Authorized Agent for this project:
_ Wiz{' l�[414r►
Owner's y�►ailing Address: Agent's Mailing Address:
J S , 6 m-a'cInik l�
PO. a 868
Email: Email: Wrightsville ar• ,�8480
Phone nr'S ' C� i d `� _ Phone �Z [phone]
1( Live/- 33-3 -- i/Zo
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and obtaining all CAMA Permits necessary to installer construct the following (activity):
�Zcyalt -le ze ' s; i�; Aor- l��'tk��J�n, S X l Ys'
For my property located at i S Wt
9
This certification is valid 1 year from (date)1
1
Property Owner Signature Date
f & cf#4* ear
P.O. Box 868
Wrightsville Beach, NC
(9110) 256-3062
6 1 ��i�!►irL�
I&M t13r f L11- iVn-1k

CERTIFIED MAIL • IRETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIOWWAIVER FORM
Name of Property Owner. Onv)b !�
Address of Property: 15+ rj�t lf') Writ il� �1'►� /�� t
(Lot or Street *, Street�d, tty 3 County)
Agents Name#: gLau �`'40 Mailing Addles/s: )? o-' �,7�/` �
Agents phone# !i�' �Sd 3G /� L"'V i
t hereby certify that I own property a*rent 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 ing. A deli rip} i5ti"dkdt'&6i6Wfh`�i hir*k�if9. rl W be provided with this ietteP.
I have no objections to th' proposal. 1 have objections to this proposal.
if you hmvo dbjacftns to whW is JWng P+oPosdd you must the Division of Coastal Xanvgement (=W in
Mft* wAWn 10 days of rw&W of no&-& Cornspomknee should ba msged to 127 Cardbw Drive Ext,
tNBrrrhVf0, NC, 28105- U& DCtif mpmenadvat east also he conbrlad at (910) 700.721ti. Aio msPote is
conslfared the same as no o kin if fou haw been ootftd tw Certlt)sd lW/r
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boa , lift, or groin must be set
black a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you mLW InMal the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Pro er Information)
__d4?
lC
Signature
J">3 kL
Prinf or Type N
MWIng Address
_6�s
- 3�3J�7
(Ad/Jacent Property / Owner information)
ST reJ'e
Print or Ty Name
Marling Address
// '/jo, i%j ._!///. /ors N
Cfly&Mt&QrP
city"ip

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner:
Address of Property: i, �r171-�1/,'lfis l�`✓/'f �" 3riE��+� ` L /�, C . f it{'��
n (Lot or Street #, Street or Road, tity & County)
Agent's Name #: �,�r !�1►% ii Mailing Address: 1 e �stix'�l
Agent's phone#: %u 56 06.1 ��t�si���3 11'�% t''j''1 l�l1ell 20V
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 objcctioi�s to this proposal. I have objections to this proposal.
If you have objections to what is being propos you must noffy the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should he malted to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 7M-7215. No response is
WAIVER SECTION / 1/h
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.
(Propert� O er Information)
Si,�rtcrt,u•c
Print or Type Na e
Mailing Address
ityiState"ap
(Adjacent Property Ownenr Information)
Signature
Print or Type Name
Mailina Address
al� cze L6 L"
City/StatelZ,c

3 gle earth
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