66552D - Sellers

CAMA. 10 DREDGE & FILLt� l l __ A B
I
IPrevious permit #
ENERAL PERMIT
New LIModification ElComplete Reissue EJ 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 C) F-1 Rules attached.
Name '�OSex� —
TDI-
State 0(, zlp-11�w
ed Agent 0
0 CW DEW 0 PTA *S �PTS
D OEA D HHF 0 1H 0 UBA 0 N/A
El PWS:
yes /(Wo PNA yes no
r Project/ Activity
Project Location: County f� (\A(;y*1 ( r—
Street Address/ State Road/ Lot #(s)
Subdivision
ZIP r),Iq
Phone (U) SH 0— �5101kiver Basin �VW
Adj. Wtr. Body (nat A
Closest Maj. Wltr. Body VV
(Scale:
ne Length
not sure yes no
)rium: n/a yes n
yes no
Attached: yes no
ling permit may be required by: -TOW Y\ See note on back regarding River Basin
. I nrni PInnnincy lurisdiction) I I - I - , - 4 '\ I

. /' l NC Division of Coastal Mgt. Habitat Impact Con
Applicant: •C� &V-O A�N 5
Date: L� f 05 /y
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
F
(Applied for.
(Anticipated final
(Applied for.
(I
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
d
Habitat Name
Choose One
includes any
Excludes any
total includes
E
anticipated
restoration
any anticipated
rE
restoration or
and/or temp
restoration or
tE
ternimpacts)
im acttaamount
tem impacts)
a
6
Dredge ❑ Fill Both ElOther ElVOO
O O
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NE)M CBRIi m DeowV 1 g of Envwmwmt w4 NaMW Rwwrcm
L-Aftbrited wgent Consent V%W eelweit
is
Yl NcD G doss Jr-,
is hatab t aulhorlmd to as an wq b
tax
of Prapwly

■ 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:
A. Sign ture
❑ Agent
X" ❑ Addressee
B. Receiv d by (Printed Name) C. D to of Delivery
71 -- �-1146
D. Is delivery address different from item 17 ❑ Yes -
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
II
I'III'I
I'II
I'I
I I
I I i
II i
III
I II
I II
II I
I II
II I III
❑ Adult Signature
❑ Adult Signature Restricted Delivery
❑Registered MaiIT'"
❑ Registered Mail Restricted
9590 9403 0533 5173 1336 85
❑ Certified Mail&
❑ Certified Mail Restricted Delivery
Delivery
❑ Return Receipt for
❑ Collect on Delivery
n r,.i-- n4livery Restricted Delivery
Merchandise TM
Signature Confirmation
2 �._ _ ... _�__
7 011 T 2970 0000 2462
1273 lestricted Delivery
❑ Signature Confirmation
Restricted Delivery
PS Form 3811, April 2015 PSN 7530-02-000-9053
Domestic Return Receipt

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ( CV-6 j Se— 's
1.-( (Name of Property Owner)
property located at '!-�► p VV
._ (Address, Lot, Blpc , Road, etc.)
on rn N'1 c 1.leil� c- in �i-,Iy DaZ aPA+e-,4 N.C.
(Waterbody) (City/Town and/or County)
die applicant has described to m" own below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal. \
\,-------DESCRIPTION AND/O G OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
� � • � se �'�eff vl ram,' 1.-e_.,r- �d jace�
�le�►s� R����w 4 , s L,44,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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
I do wish to waive the 15' setback requirement. g,J
I do not wish to waive the 15' setback requi
(Pr perty w er rmation)
Si ature
uo'" l sdl et�L
Print or Type Name
Ma}g Address
City/State/Zip
Xd�71mv-
t Proi
Property O er Informatior
J
Signat gr•e * � `n � `ti�a�
Print o T�7 (7 r LA
Mailing Add�1/L 2.7
City/Sttaat�lZip
11 `1 7 7 7 300 5

k.
CERTIFIED MAIL -RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City &
Applicant's phone #: Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual applying for thi
has described to me as shown on the attached drawing the development they are proposing. A description of c 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 1
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Dr
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No respon
considered the same as no ob'ection if ou have been notified b Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum disl
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial
appropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
Sign re
r,AO L s.ell�
Print or Type Name
Mailing Address
(Riparian Property Owner Information
Signature
Print or Type Name
Mailing Address