66607D - Wallace

3C.AMA / ❑ DREDGE & FILL
-f,NERAL PERMIT
�flew ❑Modification ❑Complete Reissue El Partial Reissue
. A
Previous permit # /
Date previous permit issued 2�
rized by the State of North Carolina, Department of Environment and Natural Resources /y --7
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
r
ules hedit Name f �'h IV111�Project Location: CountyAlzi�!`1/y�/
'51C'er br-)V" Street Address/ State Road/ Lot #(s)
i(%/ rl�►�iy�'1l( State IX ZIP 2e 2 ;;'L�<<.-�' �i✓��✓c'
` (9/0 ) _233 - VkyO6W,JIMA 1i/rli+ Subdivision __--
:ed Agent X. COY++ City l/y✓��t�g �I � luC , ZIP
❑ Cw i> fw EkKA ❑ ES ❑ PTS Phone # (�) J[' ���sRiver Basin t' AO
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A /
Adj. Wtr. Body %,Z%'%I�/ S � !g'/W (nat
❑ PWS:
yes /�� PNA yes /� Closest Maj. Wtr. BodylPf''�/�`1
f Project/ Activity leelr!!
ck) length
atform(s)
ngth
tuber
d/ Riprap length_
distance offshore
oc distance offshore
cannel
)ic yards_
rip
se/ Boatlift
e Length
1
not sure yes nAo
ium: n/a
yes
>ttached: yes /i
rig permit may be required by:
Local Planning jurisdiction)
(Scale: f Ili
❑ See note on back regarding River Basin n

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant; iyy� �a 11c� Permit #.
Date: � IA-114
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
temp impacts)
FINAL Sq. Ft.
(Anticipated Ft -
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)
W
Dredge ❑
Fill ❑ Both ❑ Other
ZAP
y�
Dredge ❑
Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑ Both ❑ Other D.
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 ❑

Pat kacCrory
Governor
AWv
r
NCDENR
North Carmii,-ia Depart-iient of Env ronmcnt &nd Notlirai Res-lurces
N.C. Division of Coastal Management
John E. Pkvaria, III
Secretay
AGENT AUTHORIZATION FORM
Date: / In ;-Pli
slame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
11ns
)wner's Mailin Address:
z-���
:mail: tip;' �/ni7te¢cL,tJ��'�RL�^G1��j,lyJ�
'hone
Agent's Mailing Address:
b w r
••s
777 MITI
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or, and obtaining all CAMA Permits necessary to install or construct the following (activity):
=or my property located at �/� /i�i�' SIR. V
0
his certification is valid r fro ( ) //a O ) �
/ I - V�J
f v i t . .

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICATIONMAIVER FORM
/ A
Name of Property Owner: J, nt l��llr
Address of Property: %�0•Z�� f��'
(Lot or Street
Agent's Name #:
Agent's phone #:
Street or Road, City &
Mailing Address:
rit/, &13lgkk% a4 lt-li� ,
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 descngtFon or drawma with dimensions must be provided with this letter.
LLjhave no objections to this proposal. _ _ _J have objections to this proposal.
ff 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 /V
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 requireme
I do not wish to waive the 15' setback requirement.
(Property Ownerltnformation), ,r
Signature
Print or Type Name
Adjacent Property Owner Information)
Signature ,
Print or Type Name

CERTIFIED MAIL. • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: �11tt E'll%�Z
r
Address of Property_
H&
(Lot or Street *, Strim or Road, City S Codnty)
J
Agents Name* `tiZd l'�1 �� Mailing Address:`` �t
Agents phone#: d %- 3'-6oL filiftimuok
I hereby certify that I own properly 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 desmotion or do w ng. with ditr Mlions. must be provided with this le#Af
I have no objections to this proposal I have objections to this proposal.
PLi �-*4A )6*1V 01.16
if you have objections to what Is being proposed, you must notify the DMslon of Coastal Management (DCAF) In
w i teg wWrin 10 days of mceipt of this no6m Corrrsponde►tce should be mailed to 127 Cardinal Drive &t,
WAmItWon, NC, 28405.3045 DCY rep+oaentitWas can also be contacted at (910) 79&7215. No response Is
e neniAwed the same as no obieadion N You have bean tlotiAeal by Car~ MaH
WAIVER SECTION Ph1
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 IS' setback requirement.
I do not wish to waive the 16 setback requirement.
//A
`Pint or Type Name Print or Typo Name
fix. _ i , ^'Pik8�

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