66534D - Stones

] CAMA / ❑ DREDGE & FILL
3ENERAL PERMIT l� / �{�l� Previouspermit# A B
rNew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued_
-ized by the State of North Carolina, Department of Environment and Natural Resources nn
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC l i 1 14 -2 GEC
�y es a hed.
t Name �r� �.' / rnLJ Project Location: County
e/,
ZIP -
(jkt ASS G' —25 -Mail
ed Agent f� �
❑ CW CAW CPiA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UIBA ❑ N/A
❑ PWS:
� j;) / no PNA yes / o
Project/ Activity
:k) length
tform(s)_
Platform(s)
igth
nber
I/ Riprap length
distance offshc
c distance offish
annel I
is yards
'P — —
Street Address/ State Road/ Lot #(s)
j '
Subdivision_✓
City I&// ZIP 2-S7`
Phone # 21k' Zl%2_ River Basin e� p
Adj. Wtr. Body / _� C_� n nat
Closest Maj. Wtr. Body % //�: - e- s�.r
N■■1-■■t■■■■■■■■■i
NUANIUMONEW
Len h
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SIR
FunnIoNMI
limp. 1 .0
(Scale: / s
❑ See note on back regarding `fiver Basin

NC Divis1011i Of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:7a4,�e S' 57 �' Permit . �/o
Date: 'V 'eA6
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fina
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/
restoration or
and/or temp
restoration or
temp impact
6/V1
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 0 Other ❑
Dredge 0 Fill ❑ Both ❑ Other ❑

North Carolina Department of Environment and Natural Resources
N.C. Division of COasW Management
APENT AUTHORIIZA_TlON FORM
Date:,'-)& )144
fe of Properly Qwnsr Applying for Permit:
Wer's Milting Address: h
iZ A
a-;w A ., oZ780,
�� cat 60, 101
.John E. Skvada, III
glary
Name of Authorlind Agent for this PrciW:
�G •
Agent's MaKHg Address:
_:.:. :. •'• 1
;r#ify that I have authorized the went listed above to act on my behalf, for the purpose of applying
all LAMA Permits We.
r my property located at
y to install or construct the following (activity)-
ttA,
L,✓%Jzt*NC28Y
Of'k
is oeroncabon is valid 1 year from (date) J )�S -�,, `
PO, kx%8
Wthtaft NC 2W
('910) 256-3W
b` 6f -fi, 5/-w AV

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: �`Lt
Address of Property: l l bewl-x+ H, 't-yy 3, l-/Wn:<<;vr, )C
(Lot or Street #, Street or Road, 6ty County)
�, n
Agent's Name #: 6-1 151-yi o Mailing Address:
Agent's'phone#. ���' �5G �ald� 14/ifiod/j i lid yw
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 area proposing. A desGriatton or drawing with dirnensions must be provided with this letter.
V I have no objections to this proposal. I have objections to this proposal.
N you have er6jec7ions to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt o/ 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 some as no objection if you have been notified by Cer0gd 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.
Pro Owner Inform n) (Adjacent Property Owner Information)
igna re Signet
J 1r-, Sfiirf� AIM N, 64,&r,
Print or Type Name Print or Tjpe Name
� � Lwtlsficlrk� N���z: YJ>i . d l
`l � 1�l � 6 i ��► �►►r,� s �l�
Mailing Address Marling Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: J i l"l )XITE
Address of Property:
(Lot or Street #, Street or Road, dity I County)
Agent's Name #: >rl� �`"lr; jt Mailing Address: 1 ^ /��'� ��6
Agents phone # 1 ,C - �ti/ r1L I t 1'j f C y (+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 desgri2i0 or drawing with dunensions must be provided with this letter.
LW& I have no objections to this proposal. I have objections to this proposal.
Ifyou have osVecitions 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 nottfred by Cerlrfied Mail.
WAIVER SECTION N 1q
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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
P76me't
Fly Owner informs . n)
r ��,
J /r'.h 5&P.4
Print or Type Name
(Adjacgnt Property Owner Information)
Signature
%/I/hmj
Print or Type �Nja
Mailing Address
i; law
Mailing Address
1.1. l-,I 7.Ruh

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