69125D - Griffin

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�C IVIA / ❑ DREDGE & FILL
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GENERAL PERMIT Previous permit#
)Jew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
drized 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 ]j7 ii 1�
nt Name f� t 6" 4 5v1 ("'O�
s�1 l_ U4 (AI 0a61 A,0CN-1
-7&A�'Gw at state N L ZIP a gt 1
(b �) " j S E-Mail �r
!zed Agent r ci
d ❑ CW )KfW KPTA ❑ ES 1 ❑ PTS
❑ OEA ❑ ll ❑ IH ❑ URA ❑ N/A
❑ PWS:
yes / (o) PNA yes /
A Project/ Activity _
i� ,
ock) length 14 !2 1
Natf
orm(s) 77 X 12'
length
umber
ad/ Riprap length
vg distance offshc
iax distance offsh
channel Y
ubic yards
imp
)use/ oat
Bulldozing
ne Length Q
notsure yes
3rium: n/a yes
yes
Attached: yes
h�
❑ Rules attached.
Project Location: County Y\AT� n6-T
Street Address/ State Road/ Lot #(s)
I ce(A L4 Ovw
SubdivisionOct a vi
/City a *1 ZIP - g�
Phol CAW) r River Basin
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale: 1 —
v
Jing permit may be required by: D%L 1/l &cu ❑ See note on back regarding River Basin

NCDETIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Freeman
Governor Director
Secretary
AGENT AUTHORIZATION FORM
Date:Date:yjal ' 1
Jame of Property Owner Applying for Permit: Name of Authorized A ent for this project:
)wner's Mailing Address:
-(Ave,
hone Number fv S�
Agent's Mailing Add s:
��-)J La
Phone Number I
:ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
r and obtaining all CAMA Permits necessary to install or construct the following (activity):
�r my property located at
1 t `5 C(M1I �,
is certification is valid thru (date)
ves _151�Ai L,oc Yl1
Pro rt ner Signature Date
i

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ffOR A PIER/MOORING PILINGSBOATLI.FTIBOATHOUSE)
. t
I hereby certify that I own property adjacent to lib(CL,�-�- -� l�s� t�, l e;
` (Name of Property Owner)
property located at _I I Ce0-C) I \N SA
(Lot, Block, Road, etc.)
on cif 1 VA—
—, in .. OCCO '1 `51 C F , N.C.
(Waterbody) (Town and/or County)
Applicant's phone b-'J LL1 ailing Address: 0091
15TE k1 C co�t i,,p
Ile has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
J do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature
6��--kv —+KOK-�
City/State/"Lip Print or Type Name
YL, i I ne*;k 11) 1)/DnK` ---1 /1-," f

US MAIL
CERTIFIED MAIL, -- RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERRTY OWNER STATEMENT
Name of Property Owner: � L l%
Address of Property: �, �J --Cco:k)_ 1--)1 e Vti C c) 1 �, V
r]q �(, (Lott or Street N, Street or Road, City & County) ,
Applicant's phone /l: L' ,%1 U� ✓r l_ ✓ Mailing Address: C `� � %yM a no( ft\r
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 description of drawing,
with dimensions, must be provided with this letter.
V/ I have no objections to this proposal. I have objections to this proposal.
If 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
I understand that a pier, clock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
IS' 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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signal -
Print or Type Name
Mailing Address
City / State / Zip
(Riparian Property Owner Information)
Signature
Print or Type Name
j o 2 i 1 m a rq c% .�)Y
Mailing Address
City / State / Zip

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PIL/NGS/BOA7ZIFTIBOATHOUSE) (j
1 hereby certify that I own property adjacent to 1a9_
r,
(Name of Property Owner)
t
property located at 1 D occ—an 13'e W e �'� byci
(Lot, Block, Road, etc.)
on U 1 Il��! , in Dt^iIS I e bEa(j1 , N.C.
(Waterbody) (Town and/or County)
700 WM i Iav� �d ave,
Applicant's phone q: ailing Address:
'1 nr2 ty � ta�gl Ia
Ile has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I S) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
1 do not wish to waive
_ I do wish to waive that setback requimment.
----------------------------------------------------------- -•------- ---------— -------------- ----------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------------------- ............................................
(information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature
City/State/Zip Print or Type Name
ids Telephone u Telephone Number
—
SieXatuoe Date �— Date

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REOUE STED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: a C [? . r 5 el i'1 T 'I
Address of Property: I r' D I�1 t� W(�c� ` —ayd
11 ,, (t.ot or Street N, Street or Road, City & County) ,�
Applicant's phone 4:��`1�U� O� Mailing Address: 1aoc� � ,and A-t�
Monrk)E Nc �z
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
has described tome as shown oil the attached drawing the development they are proposing. A description of drawinu.
with dimcpsions. must be provid with this letter
I have no objections to this proposal. I have objections to this proposal.
If 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 slould be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DC.M representatives can also be contacted at [phone]. No response is
considered (he same as no obiection if You have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.)
F I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' set back requirement.
formation)
Print or Type Name
Mailing Address
City / State / Zip
Telephone Number
(I2' srian Property Owner Information)
Sign
Prmt or Type Name
Mailing Address /
City / State I Zip
Telephone Numbers
Date �� Date
127 Cardinal Drive Exl., Wilmington, North Carolina 28405-3845
Phone [phone] FAX: [phone]G41Internet: www.rx:coaslalmanagement net
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