69067D - Edwards

_0CAMA / ❑ DREDGE & FILL �pj ►( i{ �7
3AENERAL PERMIT Previous permit# A
JNew .—Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
irized by the State of North Carolina, Department of Environment and Natural Resources r�
Z-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC V
Rules ttached.
it Name 1 r^ ' G �1 (' j J_ f �1 f!a `ds _ Project Location: County /
i H C Yw r /5��^^ Street Address/ State Road/ Lot #(s)
State I '�— ZI P.LO `-b�
M 'I Subdivision
:ed Agent ct MA&& &-rQ 111D ' City
❑ Cw 'eEKPTA S S3a7 Phone #� River Basin
❑ OEA O HHF ElIH El'1/nUBA ❑ N/A Adj. Wtr. Body G�.M A 1 �;
❑ PWS: nat
yes .tV rio Closest Maj. Wtr. Body
PNA yes /
F Project/ Activity J/)� $ '/,q / / U y'
ck) length
atform(s)
ier(s)
ngth
%RJr
p length
distance ffshore
Lc distance o ore
cannel
sic yards
1P —
Length -+t— —)4
not sure yes
lum: n/a yes o
yes no
attached: yes no
n
(Scale: X G
. h �� ,
ig permit may be required by: (�/' k not o regar��r�al
_ocal Planning Jurisdiction) / / / /) — 'J I �

NC Division of Coastal:l lit. Hleibltat impact- computer Sheet
Applicant.
Date: - Z
Describe below the HABITAT disturbances for the application.
All values should match the name,.and un is of measurement found in. your Habitat code sheet.
TOTAL Sq: Ft. FINAL Sq. Ft. TOTAL Feet Fit
(Applied for. (Anticipated final (Applied for. (Ar
DISTURB TYPE sturbance.total disturbance. Disturbance dis
Di
includes any Excludes any total Includes. EX'
Habitat (dame Choose One anticipated restoration any anticipated res
restoration or and/or temp restoration or ten
ternim acts impact amount ternirn acts am
W Dredge ❑ Fill ❑ Both ❑ Other
Dredge C7
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑ :
Both ❑
Other ❑
Dredge ❑ Fill ❑ ` Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑. Fill F1. Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 3 - I `l —/'l
Name of Property Owner Applying for Permit:
Mailing Address:
PW-
I certify that I have authorized (agent) act my
behalf, for the purpose of applying for and obtaining all
CAMA Permits necessary to
install or construct (activity)
at (my property located at) 1G 5 � Al —
Thus certiricatioa is valid thru (date) V
Property Owner Signature Date

CERTIFIED MAIL. • RETURN RECEIPT REQUESTED
DNISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFIGATiONMiAIVER FORM
Name of Property Owner- S
Address of Property: . /G.5'y _ /j tf
(Lot a street 9, Sbeet or Road, City &
Applicantphone# MaftMdnw&.93$ fic-r
w
I hereby certify that I own property ad0oent to the above referenced property_ The individual
applying for this permit has described to me as shown on the aifached drawing_ihe development
they are proposWq. A description or dr mng with ding rrsions_ must beQroyided with this letter_
iI have no objections to this proposal_ _ I have objections to this proposal.
Nyouhaveobjec6ons6owhat isbeMpWos-d,YOumust►G&fyUreQv'wD"ofCoastalManagem nt
IEKM) IR WrRWM Wi` M 10 days of rw e(pt of ans nohee. Cw,faet irrlbrrnadon for 0CM oftaces :5
avadama at WWW dcMhtq, « by Cegfng 14M-4RCQAsr /fro
response K oo�s dared same as rw ogecGon ;f yoo tare been rwtified by Cer~ MWI
WAIVER SECTION
1 un and that a Pier, dodo, MOOring pilingS, breakwater, boathouse, or fift must be set back a
minimum distance of IS from my area of riparian access unless waived by me. (it you wish to
waive the setback, you !qgg initiat the appropriate blank below.)
I do wish to waive the 15 setback requirement.
1 do not wish to waive the 15' setback requirement.
( Ow In atkmlt
&gnahme
l i eliA - / -k- ' ,Gi Lr�; tit s
Print or Type Name
_ sg
~Ing Address
L/r,74c rt . 1V e-
c4lstaftlrP
(Riparian Property Owner Information)
e\ov" Q 'a-e LLC-
Prim or Type N&m
Mauling Address
Ila, im Pez-Fea <A IVQ Vff ` 3
c wZip

oL c
ADJACENT RlPARO M PmopERTY OWmigt MCTFICATIOWWANER FORM
N m of property owner , ��t,Ch,1,1 xki;�s
Address ct Property: /45y l.� f • S�r� ���y A L (,%A j�o w
pat of 9ted 0, 94vd ar Rwd, CI V b CmiM ----
AppkarAph"� gm 94e-1d,:g j UnkmAddiem AS% ,�;hehurst�a•r-
1 hW by oertiiy that t o+rn Ply bD the dwft refeenced praiperty. -eta Irxlividuoi
apOft for Ills pemtk has dewrdW m me as dMn an re alcactted drank CVm dev�
ftw s>?
I have no 0tf9 060ft bn this Fopmd. E lame obj*WO ns m WA proposet.
iPyvn rirrnae�preaTa•s aa+rbs[ i• eatprpapo� �oermr�ac�a�y�Arri�:oadcorsitw.rt
iW In wlrp mftb 10 doo of titaipt of We addipw Conjw irdatasfioti for AM aok - b
iVs at _ or bjr ca0 s fmw�m Mo
r..Ponsr !s aunefd rrdso same as no - 1W , 0. Jf rn•r �!m am A ft §-*- led0 of
WAMt sE TM . _.
1 r(tderS'MW lited s pier, dcdr, mooring pillrgs, bneabrales, boettOgNM or At rrAt bg sat beck a
MWOTKM +Aanae of 16 front My am of rip 1; r aoosss &KIM= Mlei- 19,14 by M& (if you v4sh to
wait* ft seA)aci.. yotr mast ir>i6d the app m ift biaoir below.)
_ i do vd5h to waive ttre 15 se9,no oeWiRorait.
3 it"
! do slot +rids to naive the 1 s beck rawkemerrt.
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