66272D - Rabon

CAMA / ❑ DREDGE & FILL \(,-/(I'�
'7 A B
ENERAL PERMIT Previous permit #
ew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
wized by the State of North Carolina, Department of Environment and Natural Resources + Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC -{ J
ules attached.
it NameF Project Location: CountyL(,A-
FJ ► Street Address/ State Road/ Lot #(s)
C
State Z3c11G tU w-, ✓ lX( Y-e:
P ) 4 " E-Mail Subdivision N JA
zedAgent !V j ld J6 t ey i' ZIP
Ag k.�v� �wiaskl airy V rr��
I ❑ Cw WW XPTA ❑ PTS P n # ( (� ) V — River Basin
ElOEA ElHHF ElIH ElUBA ❑ N/A Adj. Wtr. Body i nat
❑ PWS:
yes no ) PNA yes / no-) Closest Maj. Wtr. Body
LO
of Project/ Activity
VNI .
Eck) length_
'latform(s) _
g Platform(s)
ength
ember
ad/ Riprap length_
ig distance offshore
iax distance offshon
:hannel
ibic yards
mp
use/ BoatliftT
ne Length
not sure yes _no�
mum: n/a ,,yes, _ no
11
l -1 ya < <r
(scale:
Attached: yes ( no
ling permit may be required by: ❑ See note on back regarding River Basin i
Local Planning Jurisdiction) t , „ I ' G _ i _ . . 1 i,, '

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant. ►/ �. Permit #:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
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
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fin
disturbance.
Excludes any
restoration and
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
3�' 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 0 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Fre(
Governor Director Secr
AGENT AUTHORIZATION FORM
Date: 1 i 'Zoib
Jame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
ro
)wner's Mailing Address:
a'
'hone Number Ak\ ) 43+6660
Agent's Mailing Address:
\i512
Phone Number Lc lam)
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 install or construct the following (activity):
(my property located) at
C't, „.30
This certification is valid thru (date) tho-a--.

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: To;r�--i L6u
Address of Property: 306
AA JJ (Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address: -H U %,--,C��J La21
Agent's phone #: (—q t� ��-ij�— �{'� S� >C,, f-4
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 developmen
they are proposing. A description or drawing with dimensions must be provided with this letter.
ATV
j' A 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 Ert,
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) M�d*cropertyOwner Information)
Signature
14A-/'.N IVY �,o•, e�,', N�Ch`:�/'�� I C, r-,1-hlc,- 1___qu©n
Print or Type Name Print or Type Name
�`1 U i � dtc�� � �r Z22 � • Mad Ij+. Un,-3'
Mailing Address Mailina Address

■ Complete items 1, 2, and 3.
■ Print 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:
IIIIIIIIIIFIII IIIit 11III IIIT 11111111
9590 9403 0364 5163 5269 70
2. Article Number (Transfer from service label)
PS Form 3811, April 2015 PSN 7530-02-000-9053
■ Complete items 1, 2, and 3.
■ Print 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. Articl- ^ ,- .o.
v��+3Ci
A.�i nature
x ❑ Agent
T'te
Addressee
]B.Receiv� by (Printed Name) of /Del' ry
D. Is delivery address different from item 19 13 Yes
If YES, enter delivery address below: p No
Service Type
El
❑ Adult Signature
❑ Priority Mail Express(D
❑ Adult Signature Restricted Delivery
❑ Certified Mai10
❑ Registered Maill°
❑ Registered Mail Restricted
❑ Certified Mail Restricted Delivery
Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
❑ Signature Confirmation-
0 Insured Mail
❑ In Mail Restricted Delivery
„o. e.—
O Signature Confirmation
Restricted Delivery
Domestic Return Receipt
❑ Agent
❑ Addressee
(Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: p No
II I IIIIII IIII III I ill l i l IIIII III II II I►I ► ►� a iu
3. Service Type
0 Adult Signature
❑ Priority Mail Express®

I-

-7�1 IX591
= 0e x8
HZ7 =J1i}
'o �Vls»

ti
so
416
VgK- I t9wu
t12
ook.lL