66646D - Taylor

CAMA / ❑ DREDGE & FILL Y­%A
IENERAL PERMIT (.0���6 - ` permit A B
/ Previous permit #
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources' ` L ��
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
"j \ ❑CRyles attached.
:Name 1 ` ��,\ Project Location: County
2 (� 0 TVI " 1 Street Address/ State Road/ Lot
N _,
#'PtWf 0121 I State ')�i .%
-,
P
E-Mail Subdivision
:d Agent City ZIP 2i'CG
❑ CW J EW X PTA ❑ ES ❑ PTS Phone # ( ) -&vipr Basin
❑ OEA '❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body �A,.�i/t /S Sdr� y a n
❑ PWS:
✓es PNA yes no Closest Maj. Wtr. Body ��'` ?
I f
Project/ Activity
k) length_
tform(s)
Natform(s)
igth
nber
I/ Riprap length_
distance offshore
K distance offshore
annel
is yards
p
r
Length / ✓ .1
not sure yex' no
Jm: n/a yes no
yes no
ttached: tK no
(Scale: f I l
ig permit may be required by: % ❑ See note on back regarding River Basin
.ocal Planning jurisdiction)

NC Division of Coastal Mgt. Habitat IM jsaot Computer sheet
Applicant:
Date: G
Describe bel w tl e'HABITA 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. TO7FeetFIP
A lied for. (Anticipated final (A(Ar
( pP.DISTURB TYPE Disturbance total disturbance. Didisc
Habitat Flame Choose One includes any Excludes any tot.Ex(
anticipated restoration any anticipated res
restoration or and/or temp restoration or ten
tern im acts im act amount tern im acts) am
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 El Fill ❑ Both ❑ Other El

CERTIFIED MAIL RETURN RECEIPT RE�IUE` �
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONWAIVER FORM
Name of Property Owner: C 4a,/u
Address of Property: 7S SiY St Gt /
A yu�
(Lot or Street #, Street or Road, City 8 County)
Agent's Name #:
Agent's phone #:
Malting Address:
I hereby certify that 1 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 ra is must I- provided with this lette .
�I have no objections to this proposal. I have objections to this proposal.
ff you have objections to what is beMg proposed, you must notify the Division of Coastal Management (DCM) In
writing within f0 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405.3845. DCM mpresentatives can also be contacted at [phone]. No response is
considered the same as no oblection if you have been notified by Certified Mail
WAIVER SECTION
t understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a inimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to aive the setback, you must initial the appropriate blank below.)
t do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro rty Owner 1 ormation)
Signature
ftlk Kai Arl w
Print or TypaWame
607S SiIa7sr
Mailing Address
CitytStatel7ip I
Telephone Number
4 -/ r- /4
(Adjacent Property Owner Information)
iV& J
Signature � 'tzw�c �• L^�
ti i ISO
Print or Type /Yams f�
Mailing Address ac ECEI VEp
� P/Ir
. JP C_._ AYPLMINGTONr N,
T_
CitWStats iZ r- 1UN 13 2016
Telephone Number
Dale
Date

ADJACENT PROPERTY
STATEMENT OF
NO OBJECTION
I hereby certify that I own property adjacent to o /^/s
(Na a of Pr�rty er)
property located at 6 D 75" SYA4 Yfree f �,. G'r� N C a—�ir�,e" r-
- (Address)
one ( in Surf City, N.G.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),
the development he is proposing at the above referenced location, and, 1 have no
objections to his proposal.
- jor
ig 5Na -� � Phone Number
(—
Print or Type Name
RECD
MING ON, NC
AGM WIL
SUN 131%
Return form to:
91
Division of Coastal Mgmt.
127 Cardinal Drive Ext.
Wilmington, NC 28412
Date

i
■ 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 mailplece,
or on the front if space permits_
I. Article Addressed to:
�t
e,,Af K SA, kl,'6r
��ane AJ C
1111111111111111111111111111111 IN 1111111
9590 9402 1873 6104 4646 44
2. Article Number (Transfer from service labeq
015 1520 0000 4894 0594
4 PS Form :its 11, July 2015 PSN 7530-02-000-9053
A. Signature
� J
Received by (Printed Name) C.
D. Is delivery address different from item 1 i
ff'Y�ES enter delivery address below:
1�
a,
a >,cluit s��
Cl Adult Signature Restricted Delivery
Certified Mail
❑ Certified Mail Restricted Delivery
U Collect orr9eWmiy-
0 Collect on Delivery Restricted Dernrery
_. ❑ Insured Mail
❑ Insured Mail Restricted Delivery
❑ Priorl
❑ RegG
Deiii
0 Retu
Mery
❑ Sigr
O Sigr
Res
RECEIVED
()CM WILMINGTON, NC
_IuN 1 3 206

ADJACENT PROPERTY
STATEMENT OF
NO OBJECTION
I hereby certify that I own property adjacent to 1 `&7
(Nee of Property er)
property located at D75` S?'Ni Y?�-tPf c1u N C
(Address)
on CAVC( / in Surf City, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),
the development he is proposing at the above referenced location, and, I have no
objections to his proposal.
-.aCAJ-V796
S+ ature Phone Number
ryc" C. -5GtJ o✓
Print or ype Name
Q� w/4CF/
'loN 13?Q16 N, NC
Return form to:
NCDENR
Division of Coastal Mgmt.
127 Cardinal Drive Ext.
Wilmington, NC 28412
i�,--3-2014
Date
t

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Stephen Shackleford
Address of Property: 6077 Sixth St Surf City NC 28445
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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.
roperty-Own r Information) (Adjacent Property Owner Information)
Signature Si alure
Nancy Taylor
Print or Type Name
Print or Type Name
6075 Sixth Street
Mailing Address
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Richard and Nancy Taylor s
property located at
6075 Si�thaTrreet roperty Owner)
on canal
(Address, Lot, Block, Road, etc.)
, in Surf City
(Waterbody) (City/Town and/or County)
, N.C.
The applicant has described to me, as shown below, the development proposed at the above location
_ I / I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waiv
the setback, you must initial the appropriate blank below.)
.SS I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
i(""J)
C-
Signature Sig Lure
lancy Taylor � � C
Print or Type Name Print or Type Name
6075 Sixth Street q- ? q ,L,' 1'7-

• Complete items' and 3.
• Print your name address on the reverse
so that we can rithe card to you.
0 Attach this cart to the back of the mailpiece,
1. Article Addressed to:
f
111j'A #1 T 11111111111111 111
9590 940 373 6104 4445 14
AxArticle
Number tip9 15 1520
:orm 3811, id
1 4894 0921
PSN 7530-02-000-9053
[3 Agent
[I Addres
14 of 064%
D. . Is delivery address different from Item I? u Yet
If YES, enter delivery address below- [:I No
3. Service Type
0 Prionty Mail Express
0 Adult Signature
0 Reg'stered MaJITIA
X""S"Signature Restricted Delivery
0 Registered Mail Res
Malle
* Certified Mail Restricted DeNvry
Detwery
Return Receipt fc-r
* Collect on Delivery
eoc,,a iise
* Colect on Delivery Restricted Devivery
Confirrnzr
Ond Mail
Q Signature Confirma
W,ed Mall Reartted N- 96 eery
Restri&ted Delivery
I,Alel$51-111)
Domestic Return Rin

am
m
M
7
7
y

ello"d D?j
/J(ttes,Y�iAhyf
r) ,6 d
�-V7ZX TD jE
i4 �ff/fok/
S/40,1 /°,fir

T
L