69363D - Edmonds

CAMA / DREDGE & FILL t6/a3'� A B
GENERAL PERMIT Previous permit #" �-❑ip
New Modification Complete Reissue ❑Partial Reissue Date previous permit issued?/`
)rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
it Name } rail k u n'l C) "AJ Project Location: CountyAle 6.V H- w c V-P r
'kav1vH-(S i11f_ State VA- ZIP 20,101
(MI )IIk iU0 E-Mail 4St'd6i1WAS�'►i' �!j•
i:ed Agent Cd F) ►l 11
❑ CW XEW IXPTA X,ES �("S
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
Street Address/ State Road/ Lot #(s) 14 + PI y ,s
CUNT Subdivision Fi l ukt e sl a l td
City l,Ilii/t 1011.4 1 ZIP
A rAhone # (M) �3WI River Basin ra or
Adj. Wtr. Body 6aklksOut ti fu l nat
5s
/ no PNA yes / no Closest Maj. Wtr. Body I 4
f Project/ Activity Qf dui I UV C 4 [Al `ri'yC{iit 2 i`5 / t vk r w rd al- -e.XIShKcj
(Scale:
length
id/ Riprap length I W rJ .
g distance offshore . S 1
ax distance offshore ? • g,
v p Q
ng permit may be required by: N� � a r CD. NQhovI A(k I C I kli d ❑ See note on back regarding River Basin r
I nrnl Pinnnina hiriarlirtinnl

�.CAMA / �j'DREDGE & FILL Q' 3 , � .� 1 ®� A B
GENERAL PERMIT Previous permit#
New __Modification ❑Complete Reissue Partial Reissue Date previous permit issued
6rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0
Rules attached.
.nt Name 7Y L GAProject Location: County & ii/ 4a �1 ly-� r
s Y1 �Y , Street Address/ State Road/ Lot #(s) 1 t'
lati0t1f5 1AiLt State yA ZIP �2�b1 N�Gk- lid.
# (41) 11 ie R leo f-Mail r-_-;t_0d W D ftCN A!!l . Subdivision
ized Agent F' q ,y VA [At1 [_City.
fin/ 1 Vt,-j-fL h zip
d ❑`�" ` CW C�PTA NOES VPTS =` 'Phone # (�) t�(F��GZ River Basin C"r
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
no PNA yes
Adj. Wtr. Body &fJ/1 ; C44 rl r4 I XnaP
Closest Maj. Wtr. Body. _D__,_1,d(_ 1
A Project/ Activity P v l fl u t V"y I � r tm i,y j+ l t_a d Z- ' (21
2� i t' � J J, &JLA hAg - (Scale:
lock) length
ig Platform(s)
length ■■■=■■�NEiumber
■I®1■ ■1■■■®
■■■ :■1■1O■■■■■■■1173"'1 An
vg distance offshore
nax distance offshore
■■■■■■■■■■■■■■■�■a.�►��■r,,n�
channel
�ubic yards
amp
■■■■■■■■■■�11�■■■�■■■t■�ila►j�
■■■■■■■■■■■■■ ■■■■■■■■■■■■I
■■■■■■■■■■■■■■■■■■■■■■■■■■I
ine Length I (�
not sure yes l/
orium: n/a yes
s: no
� ' I
r Attached: yes 67
ding permit maybe required by: V Ha '1 cW t ` Uu;1 t ❑ See note on back regarding River Basin
0 1 ..col ph... i-

Nib o1visaon of Coastal Mgt, Habitat Impact :+aMPUter "t
Applicant: �'�-L�
�V1,�+Ir S' C/O Y,, Perrmit #:
Date: 0 ' M , L
Describebelow the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
t
TOTAL Sq. Ft,
FA
ll
(Applied for. (An'
DISTURB TYPE Disturbance total di
Habitat Dame Choose One includes any
anticipated r
restoration or a
temp iinp((acts) im
5 Dredge ❑ Fill Both ❑ Other El
Dredge ❑ Fill El Both ❑ Other 0
Dredge [I Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill El Both El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ElOther ❑
Dredge ❑ Fill El Both ❑ Other ❑
[IDredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both El Other El
Dredge ❑ Fill ❑ Both El Other ❑
Dredge ❑ Fill El Both ❑ Other ❑
Dredge [I Fill El Both ❑ Other [IDredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
n
L. Sq. Ft, TOTAL Feet FA�Apaced final
tCipated final (Applied for. nce.
(Antici
(urbance. Disturbance disturba.
Excludes any total includes Excludes any
esbration _ any anticipated restoration and/or
ndbrtemp restoration or temp impact
amount) temp impacts).amount

"E1VE
j FEB 17 2017
Q A
NCDENR
North Carolina Department of Environment and Natural Resources
Fa! t,11-crori John E. Skvarla, III
ve mcr Secretary
N.C. Division of Coastal Management
AGENT AUTHORIZATION FORM
Date: 3 3/in 0�
NNarpe of Prop" Owner Applying for Permit:
/. L�
47 91rL", G t LLC
Owner's Mailing Address:
$ S lzelil " ,'VI
G•.Uk4ir it A i 1,4 1290
Email: F1 EQMoA1l1/ U' ��L. (�i✓1
Phone L 1 jZ -_ L_L_ J IU
Nawf Authorized Agent for this project:
Agent's Mailing Address:
-�
Email: (910) 0.
Phone L-1
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, p��d objy.�'ining al CAMA Permits necpTgsary to install or construct the following (activity):
/I/ ��f/._ .__1 _ -� 1 _ • .— I 1 A._ tint
For my property located at 7 1DeYP&k
f �
This certification is valid 1 year from (date)
Property Owne gnature ' Dal
f & ,f #wo s ew"aw, Av
P.O. Box 868
Wrightsville Beach, NC 2848(
[phone]
fow
Sfi
.. 11.11

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of Property Owner:
Lfq '�t
Address of Property: ! ` j !W 11afi� 0 4474417M, Al-6 2 J1
(Lot or Street Wtreet or aad,-bty & County))
Agent's Name # _ Mailing Address:
Agent's phone #: ' 3 � s�, �, �+ �► IVY&
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
hey are proposing. A desariplion or drawing, with dim#nsions, must be provided with this letter.
I have no ohicctions to this propo,,al. I haNc ohicctions to this proposal.
if you have objections to what is being p►oposed, you must notify the Division of Coastal Managwnent (DCltl) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext ,
Wilmington, NC, 28405-3M DCM representathres can also be contacted at [phone] No response is
considered the same as no objection Nyou have been notified by C Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, b2se, 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 Wow.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(PropgrJ Qwne Igformation)
VV �i � rIA . c.+t
SiKnulfh-0 C �j
Print or Type Name
Mailing Address
V"*-`N"`rA 22,101
/a y" 0
Maiiirrg Address
Girl)wwwur, uy� ?,�3�►l

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN
PROPERTY OWNER NOTIFICATIONIWAIVER%
FORM
Name of Property Owner: �'�"�` a -I MA , (43 �1 N (�l_-
t/ lip 11br�L .Y*4N.J. 2hj)
Address of Property: ? � � f 1 N•L`'
(Lot or Street If or Woadity & County)
g f),>
Agent's Name #: Mailin Addre�sjs: Agent's phone #: `02 " 3 �t/i'k�l�lSa l�� G► Z000
1 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 pr ing. A description or drawing, with dimensions, must be provided with this letter.
I hurt no of icctions to this proposal. I have obi�xtions to this prtjx,�%il.
if you have objections to what is being proposed you n►ust 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,
Wumington, NC, 28105-38I5. DCM representathws can also be contacted at [phone]. No response is
considered the same as no lion if have been nofi/ied b C ail.
WAIVER SECTION N
1 understand that a pier, dock. mooring pilings. breakwater. boa use. 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 musinitial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Propj QAwnAd 14formLtion)
SigtrrrJ rr 1' f,�
4: `; L" l `
Print or Type Name
Mailing Address
G"I��`, �h 22,of
(Adj nt Property Owner Information"
Signature
#A, L/06141-d ax�rm�
Print or Type ame
f / 6 A�M�f6h iliu�
Mailing Address

�o gle Far
6J)4Z-Wliqm-f}
P/�w yLnk
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