67145D - Ocean

�(Q,.;MA /.❑ DREDGE & FILL ``V / I 4 A B
►GENERAL PERMIT Previous permit#
$hew ❑Modification El Complete Reissue ❑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
OoA �a'rr-o ❑ Rules attached.
it Name fao \+ 4 Project Location: County_9v-'4_4"';( Kn-
'rj Street Address/ State Road/ Lot #(s)
State ZlP cu t.,tyi f 1 AV1f-"V1
zed Agent �� VVl '1Yli \J
��(� ✓ Ili iM
1 ❑ Cw ❑ Ew ❑ PTA
As
❑ OEA ❑ HHF ❑ IH
❑ URA ❑ N/A
yes / ino) PNA (yes)/ no
Subdivision
A City ZIP'
one nn # � L—i ) L 4 L L River Basin
Adj. Wtr. Body na
Closest Maj. Wtr. Body
if Project/ Activity ( 0V1 6 U �Pq A O �l d
xk) length_
'latform(s) _
g Platform(s)
ength
umber
ail/ Rip p length
ig distance offshore
iax distance offshore
:hannel
ne Length "" 100
not sure yes no
)rium: n/a yes o
yes
Attached: yes n
ling permit may be required by:
Local Plannina Jurisdiction) /'1
(scale: 1
❑ See note on back regarding River Basin
i

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: ©L� � ti'1 POA Permit #: l!/ � tg5`h
Date: O 403 P 6 U%
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat 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
andlor temp
im act amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/o
temp impact
amount)
Dredge ❑ Fill Both ❑ Other ❑
2 e0Q
go
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 0 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
:I F. Easley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr., Secr
L% ci Yn i� 1 J U a rf)a m is hereby authorized to act on my behalf
(Printed Name of Agent)
r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to V
activities described in the attached sketch.
LION OF PROJECT:
1IX a 1.! I �'
:RTY OWNER MAILING ADDRESS:
)RIZED AGENT MAILING ADDRESS:
�0-rl)am
d o&5f�er �v�l� fi fes
C �
. r
211MM7M
PHONE NO. ql6l - KJ — Lal 7S
` A

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVVER FORM
Name of Individual Applying For Permit: (eQV 1 �6"'V&n
Address of Property: baor ` mo 614— eod
(Lot or Street #, Street or Road)
(City and ountj)
I hereby certify that I own property adjacent to the above -referenced property. The individua
applying for this permit has described to me as shown on the attached drawing the development the;
are proposing. Ad "ption or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coasta
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3901
within 10 days of receipt of this notice. No response is considered the same as no objection i
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be se
bek a minimum distance of 15' from my area of riparian access - unless waived by me. (If yoi
wish to waive the setback, ,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I de not wish to waive the 15' setback requirement.
Sign . am Date
Print Name
AIt
E 4iv ;0

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION,%WAIVER FORM
Name of Individual Applying For Permit: '' cem �61jevll Ro/�
Address of Property:
(Lot or Street #, Street or Road)
0T_6 JVC.
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The individu,
applying for this permit has described to me as shown on the attached drawing the development the
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
J P P
If you have objections to what is being proposed, please write the Division of Coasts
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390
within 10 days of receipt of this notice. No response is considered the same as no objection i
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be se
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yol
wish to waive the setback, you must initial the appropriate blank below.)
Sign tame
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 15' setback requirement.
!12-1
Date
bm EL 9"' PAX6L?J7
Print NameA &74