67144D - Warner

hCAMA /pREDGE &FILL 1(, V O /��`� tr,
1ENEAAL PERMIT Previous Dl Previous permit# A B
New EModification El Complete Reissue El Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources O� l' O Q O�
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / Q, ,
❑ Rules attar
t Name l%Y A Project Location: County Y tiM
1 n j� Street Address/ State Road/ Lot #(s)
r �n CA State ZIP i
(� ) E-Mail Subdivision
ed Agent City ( ZIP
� vir ,k � D r
❑ CW jgj EW OZTA �ES AITS Phone # (4) ��'�U " 6Sj River Basin
❑ OEA /❑ HHF ❑ IH ❑ URA ❑ N/A
Adj. Wtr. Body (nat
❑ PWS:
yes / M^q PNA yes (nc) Closest Maj. Wtr. Body
WAo
' Project/ Activity _
IV � ►'7 ��
ck) length
itform(s)'tl (x sW
Platform(s)
ngth
tuber
Riprap lengt
distance offshore -�
Lc distance offshore
cannel !
air yards
np
ise/ Boat
e Length PP)
not sure yes no
•ium: n/a yes n
yes
Attached: yes n
Ing permit may be required by:
1 n 1 Plnnnino hiricrlirtinni
- . `, (Scale: I
n
UVy Y t �.(/� (�G ❑ See note on back regarding River Basin r

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date: Q '�V ,
Permit #:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternimpacts)
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 final
disturbance.
Excludes any
restoration and/o
temp impact
amount)
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 �] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

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ATM OF PROJECT:
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fMlbo\� E-Clo( rA C, 2"3 9(oZ
IOPEA7'Y AODRE�S:
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Raman
Slgc- ^As d Prapa" Owner.

82/07/2004 19:20 9108429B06
GREY H(JLEiEf
PrvGE 01
ADJACENTt A17rION OF COA�Tnr
Names of Individual Applying For Permit:
Address"Of Property:
(z.ot 'or Street Street oz Road
C ty & County}
I hereby Certify that I
referenced pr-opertY• Tha ot�ti Property adjacent to the
described to aes as shown individual applying for this above -
they are n the attachead drawing Permit has
should be Proposing. A description or drawing,9 the davelop�aeant
Provided with this letter..with dimensions,
------ I have no objections to this proposal.
IfAAJM $$CTTnta
I understand that a i
house, lint Per, dock, Mooringpilings,
moat be eat back breakwater, boat
frooe My area of -ri ck a minimua distance of 15,
beltcJ ow.)
the $e Parian access unless waived by me.
below.) Eck, You Gust initial the (If y°u wish
appropriate blank
-- I do wish to waive the 15'setback requirement-
--------- x IQI= wish to waive the 15'setback requirement.

03-2007 10:02 From: To:642 96
C9 1<'TFIED FAAIL - RE1nM RECETf'tREQUESTED
The purpose of this form is to Provide proper notice to you as an adjacent riparian property owner to the individu-i o
individuals listed below, 'cite CAMA Genera) Permit application prccdurts requira that appikano provide th; t}ivi.
Coastal Matwgcmcnt confirmation that a written statoment has been obtained s4pad by the adjacent riparian proper)
indicating that they have no objection to the proposed work oL that the adjacent riparian property owners have beets t
by certified mail of the proposed work. Often these forts are submitted to the adjacent riparian property owners by
contractor or other individuals acting as an authorized agent on behnirof the applicant.
This form was sent to you by the following Individual or company designated by the applicant as an
authorized agent:
Authorized
s Signature
Date
Name of Individual Applying For Permit:
Address of Property:
(lot or Stint tl. Street or Road)
(City
County)
I hereby certify that i own property adjacent to the above -referenced property. The individual appi} ing for
has described to me as shown on the attgched drawing the development they are proposing. A description t
with dimensions, should be provided with this letter,
I have no objections to this proposal.
If 'you have objections to what is being proposed. please write: the Division of Coastal tilanagi
Cardinal Drive Extension, Wilmington. INC 2840S or c211910.79&7215 within 10 days of receipt of
No response is considered the some as no objection if you have been notified by Certified IMmil-
WAIVER SECTION
I understood that a pier, dock. mooring piling, breakwater. boat house or bout lift must be
minimum dis-mace of 15' from my area or riparian access -.unless waived by roe. (U you wish t
setback, you most initial the appropriate blank below.)
i do wish to waive the 1 S' setback requirement-

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