67210D - Tewksbury

;LAMA / ❑ DREDGE & FILL
aENERAL PERMIT 1 U Previous permit # A B
New ❑Modification El Complete Reissue ❑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
_ ❑ Rules attached.
t Name Project Location: County .v
Z Z : Cre-wi itne Ln Street Address/ State Road/ Lot #(s)
Ya Suers , State ZIP18g(v r I
Z(. •3$Q 3 E-Mail Subdivision
}}�..'{ a ?y fa 11t?�bn
ed Agent City `(Aaa to t�y ZIP a 1 -�
SCW V,I EW )Z"PTA ❑ ES ❑ PTS Phone # ( ) River Basin /l
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body !ALA
❑ PWS:
yes / no PNA yes /ono Closest Maj. Wtr. Body
Pro ect/ Activity
+(l L_t, C'�c
:k) lengdfil
itform(s)
Platform(s)
ngth
nber
i/ Riprap length
distance offshore_
x distance offshore
cannel
)ic yards_
np
se/ Boatlift
ctsvI 4
(Scale_ I" = 3
V
❑ See note on back regarding River Basin r
Local Planning jurisdiction)

NC Division of Coastal Mgt. Habitat Impact Comp
Applicant: :vV\
Date: IO ll
13 I b
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
FIN,
(Applied for.
(Anticipated final
(Applied for.
(Ant
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
distL
Habitat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excl
rest(
restoration or
and/or temp
restoration or
tern{
ternimpacts)_impact
tem impacts)
amo
L�
��
amount
13 `�'
Dredge ❑ Fill ❑ Both ❑ Other
Cl)
Dredge ❑ Fill ❑ Both ❑ Other ❑
8 "[
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: jo n � 0f b UI'C(,h / e lcl
Address of Property: l,5a Cam s-r� e �`l ►�e <Si��aa�sF.err
(Lot or Street #, Street or Road, City & County)
Agent's Name #: S'W , S SUS 0 Mailing Address: ld % 6Arjlr al
Agent's phone #: 91 U — 7,16— 7a 70 Zt1d 1V 1A 71i/) /V C 5A'?'J
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 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 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 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.
J 1-) M. TeyX'�'sbvv y
Print or Type Name
/,�a 6ems6ne-qgr4le-
Mailina Address
(Adjacent Property Owner Information)
r /4C /71
Signat re ) �.
Print or Type Name
Mailina Address

t
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner: JUm 4 A,JOYah T&1d 1 / )c5 byr
Address of Property: /3a 6
Isfyh��r,�e�S�gak Ferry, Llt)) kw
(Lot or Street #, Street or Road, City & County)
Agent's Name #: 91-GOI )J`' S�� Mailing Address: /Jj��l/ y VCR
Agent's phone #: %
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 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 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 notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater,'boath ouse, 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)
JVy 4,
yature
M,
Print or Type Name
/ &a 6e%5-1oAeA1-/ IXe
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
Mailina Address

m Domestic Only
nu
0
For delivery information, visit our website
GOLOSBORO ► -`NC 127134`
O Certified Mall Fee
—a $3.30
Extra Services 6 Fees (check bar, add tee 70
❑ Return Receipt (hardcopy) $
0 ❑ Return Receipt (electronic) $ %A . rL� �A�
rn ❑ Certified Mail Restricted Delivery $ $ 0 � MCI
0 ❑Adutt Signature Required $ _$1 a-r 00
❑ Adult Signature Restricted Delivery $ '��
1] Postage
� $ $0.47
0 Total Postage and Fees
$ $6.47
Sent T(YT M- j�
o ------------------------
Street and Apt IVo., or Pt3 Box No.
f`-
Postmark
Here
10/19/2016
Postal
CERTIFIED o RECEIPT
o Domestic Mail,
nly
SNEAN
-T& L
1j,
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o $ $6.47
Li-1 Sent To
ljo6
��5treei
and Wt. %oorhl_ --------------------------------.
fpt
City, State. Z/P+4a�.,or
---------'------------------------------------------------------

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. JUm �O &C 61IYCIA r&. l / )c5 h1)t-'
Address of Property: 13a 6
Or 5/,�Iv
(Lot or Street #, Street or Road, City & County) '
Agent's Name #:rl 1-00/ 51 Iq'�l%% �Y� Mailing Address: ��7 f��l � ✓Cf
Agent's phone 6 -% A
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 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 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 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
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner„Information)
Si&al ure
Print or Type Name
/ &a I§CM5-�oAeZ// ve
(Adjacent Property Owner Information)
McOwtac
Signature
'13o4 fe/2o( Q
Print or Type Name
13einsi-CNe- �zr►r�
Mailinn Arldra.cc
Mailinrr AridrRcc

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