69430D - Dozier

.AMA'/ zA DREDGE & FILL , l� 5V A B
"ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_
irized by the State of North Carolina, Department of Environment and Natural Resources 1
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
it Name �� 1I fill W I"fit;+�)��t1 �� 1 Y Project Location: County ��{ w Ha l l c t
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:ed Agent tvdU.J
❑ CW EW Y PTA ES YJ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes / no
Street Address/ State Road/ Lot #(s) 194 it, f 1
DV IV C
Subdivision
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Phone # ( I (i') C,23b .M4 3 + River Basin
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ig permit maybe required by: 0�WA I{� U l w 1 ('V-j' CO. ❑ See note on back regarding River Basin rt
-ocal Planning lurisdiction) —" f I

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Orly Eaves Perdue James H. Gregson
.mor Director
AGENT AUTHORIZATION FORM
Date: 10 - / 6 - I �
of Property Owner Applying for Permit:
ar's Mailing Address:
ie Number (910 7b1 �qq
Dee Freeman
Secretary
Name of Authorized Agent for this project:
ems, w c� elrl %
Agent's Mailing Address:
Phone Number rlX ) 5-3
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
ind obtaining all CAMA Permits necessary to install or construct the following (activity):
h�Ck
property located) at / %
certification is valid thru (date) `y /
1 7 roperty O ner Signature
— /9,
/o L
Date

CERTIFIED MAIL - RETURN RECEIPT REOUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
lame of Property Owner: I.,l I � 1 tGQLin * f _ IIZ &LL"�1 ] )n L Ie t
address of Property:
(Lot or Street #, Street or Roat Vity &
Z
Lpplicant's phone #: 06) 4 Mailing Address: :3 1(
hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe
as described to me as shownon the attached drawing the development they are proposing. A description of draw
Pith dim1siensions must be provided with this letter.
t/ i have no objections to this proposal. I have objections to this proposal,
f you have objections to what is being proposed, you must notify the Division of Coastal Management (DC]
i writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive 1
Vilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
Dnsidered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
?propriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
'roperty Owner
Tint or Type Name
1 q T�\ (,P+
[ailing Address
r .
(Riparian
Signature
Print or Type Name
Or
MaH4 Address
f

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
'ame of Property Owner: a) ``� ana it- F 11zaU L''GL'� 1) n Z ie
ddress of Property:
Z
(Lot or Street #, Street or RoajtXity &I County) :T
pplicant's phone #: 6 Z - Q CMailing Address:
w,1 wlv\ ' . mc, .
hereby certify that I own property adjacent to the above referenced property. The individual applying for this pet
is described to me as shownon the attached drawing the development they are proposing. A description of draw
ith dimensions must be provided with this Ietter
have no objections to this proposal. I have objections to this proposal.
' you have objections to what is being proposed, you must notify the Division of Coastal Management (DCT
1 writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive I
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
)nsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
inderstand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
P from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
►propriate blank below.)
!� I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
■ up— ay vwuvr imurmauon)
Ct "h&* An�� _-P t?
int or Type Name
(Riparian Property.Owner Information)
Signa C
d3.0,t /n M.'a
L
Print or Type Name V
ailing Address
'Tr' 3 1•'JCV 1/-64A,/ ---
Mailing Address

I
171

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eAd
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APPLICANT'S NAME:
DEVELOPER:
PR03ECT ADDRESS:
SUBDIVISION:
NEW HANOVER COUNTY BUILDING PERMIT
APPLICATION TYPE: RESIDENTIAL
PLEASE ANSWER ALL QUESTIONS APPLICABLE TO FLAPPLIC
"Project Responsibility"' OD ZO�
DATE:
PHONE #-
ZIP:
BLOCK #: LOT #:
PROPERTY OWNER'S NAME: OWNER'S ADDRESS: 7 / PHONE #: 262 -off
P.iJ CITY: �1 ).lr✓1:�,v�f�tiw� ST:�%CZIP:G
CONTRACTOR:
is
biLICENSE #: ACCOUNT #:
ADDRESS:
EMAIL ADDRESS: STW ZIP: S o�tUJk B CC t i'f, (Ioti-, PHONE #: Q/o-J`��—�
PROJECT CONTACT PERSON: S rpr,
PHONE #: 0--,�3
EXISTING CONSTRUCTION: ❑ ALTERATION M RENOVATION ❑ GENERAL REPAIRS RELOCATION
11
NEW CONSTRUCTION: ❑ ;ERECT NEW RESIDENCE or ❑ ADDITION TO EXISTING RESIDENCE
**PLEASE CHECK AND ANSWER BELOW ALL THAT APPLY TO YOUR PR03ECT:
❑ ATT GARAGE SF ❑ DET GARAGE SF ❑ PORCH SF
❑ SUNROOM SF ❑ POOL SF ❑ STORAGE SHED SF
❑ GREENHOUSE SF ❑ DECK SF OTHER: / �k
TOTAL HEATED SQ FT: TOTAL SQ FT UNDER ROOF: TOTAL AREA SQ FT: 7LL//
�
TOTAL PROJECT COST(LessLot) ; $ ©, 0,0 # OF STORIES:
Is Any ELECTRICAL, PLUMBING or MECHANICAL Work Being Done to the Accessory Structure? ❑ Yes E9 No
If the project is a Relocation, is there a Natural Gas Line on the Current Site? ❑ Yes M NC
Is there Electrical Power on this Building? 0 Yes ONO
CITY:
PROPERTY USE / OCGUPANCY:0,SINGLE FAMILY ❑ DUPLEX ❑ TOWNHOUSE
)ISCLAIMER I hereby cer8fy ihatali information in Otis - :.�
appGoation is conactand all work wi8 c«nplywith ta� Building Coda and all othar applicable StM and bcal
nd ordinances and regulations. The NHC Development Services Center will be notified of any changes in the approved plans and specifications or change in contraclor r
ontrac¢x informaton, •^NOTE: Any Worrkk Performed W/O the Appropriab Permitswif be in Violation of the NC Stale 8ft Code and Subject 0 Fines Up To =0.07
OWNER/CONTRACTOR: wcC� SIGNATURE:
IS THE PROPERTY LOCATED IN A FLOODPt�l. ? YES E7 NO
XISTING IMPERVIOUS AREA • (�V)
4 ,vacs TOTAL ACRES DISTURBED:
NEW IMPERVIOUS AREA: � \
Q Y�yc1r) EXIST LAND DISTURBING PE IT: ❑ YES NC
lATER: ® CFPUA ❑ C{MMUNITY SYSTEM ❑PRIVATE WELL CENTRAL WELL
EWER: ®.CFPUA ❑ toob
❑ CENTRAL SEPTIC ❑ PRIVATE SEPTIC ❑ COMMUNITY SYSTEM
... SEPARATE PERMITS REQUIRED FOR ELECT, RECH, PLBG, GAS EUlIP_ P4F��RC R Z
C
TUcco7e sect

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pzod o-�d
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Iowa 'v
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
nn
Applicant: O'b L ( # V430
Date: al ` / �-
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
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge ❑ Fill ❑ Both [Ijj Other
� c)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑