67122D - Gay

CARRA / ❑ DREDGE & FILL
'
A B
iENERAL PERMIT
Previous permit#
New :]Modification ❑Complete Reissue ❑Partial
Reissue Date previous permit issued
!zed by the State of North Carolina, Department of Environment and Natural Resources
07 LZ 0 0
oastal Resources Commission in an area of environmental concern
pursuant to 15A NCAC
_
rr
Name ✓uY�J G{ � Gl ` -
❑ Rules attached.
Project Location: County -,I -T K
:5 CA'e
Street Address/ State Road/ Lot #(s)
s—n W State l
'„ j 'M D Lv-,c
f
/
E -Mail _
Subdivision
;d Agent (1N4 (t, ( W 4
_
wc' %�
Ccity��--�x G� b1T c It CQ t � ZIP
❑ CW � *TA ❑ ES ❑ PTS
4
I'hon" e # (Q (V 17 °I River Basin ('t�m
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body CM Vt nat
❑ PWS:
Fes / -L' PNA yes / no
,cam 1 A � " �
Closest Maj. Wtr. Body ! � ' +LV
Activity
k) length_
tform(s) A
'latform(s)
igth
fiber
/ Riprap length_
distance offshore
c distance offshop)
annel //
is yards
rl4
i
Length
not sure yes
um: n/a yes
yes
L
attached: yes lf1R
ig permit may be required by:
_ocal Planning jurisdiction) A
CW ti out hh
1
(Scale:
i iiiI0 u ONE ME
• ! ❑ See note on back regarding River Basin rL

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: L C VyY Permit #: (� '1 i Z'z IF,
Date: O Z /( C` �?- D ( 1
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
I FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
nce
disturbance.
Habitat Name
Choose One
includes any
Excludes any
des
Excludes any
anticipated
restoration
pated
Lrestoration
restoration and/or
restoration or
and/or temp
or
temp impact
temp impacts)
impact amount
acts)
amount)
V v V
Dredge ❑ Fill ❑ Both ❑ Other
OV
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑ Fill ❑ Both ❑ Other ❑
Postal Service"
CERTIFIED o RECEIPT
ii U.S. Postal
Domestic Mail Only
a RECEIPT
Q' Domestic Mail •
nly
C H 0 t 1 sd
ti
For delivery information, visit our website at wwmusjos.como.
GRE£ S��F'J 4�7 -- -
a
ertified Mail Fee
$3.30
0470 ru
certified Mail Fear $3.30
'�
$
0470
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:1 R Services & Fees (check box, add lee rote)
] Return Receipt (hardcoPY) $ 1)))
.
] Return Receipt (electronic) $ Sri tl I
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Postmark
Extra Services & Fees (check box, add /ee it )
❑Return Receipt (hardcopy) $ -
1
] Certified Mail Restricted Delivery S $n 99
]Adult Signature Required $
Here
- 0
( Return Receipt(electronic) $ 40 -of)
❑
Postmark
]Atlutt Signature Restricted Delivery j
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❑ Certified Mail Restricted Delivery $ !��
❑Adult Signature Required $ t... e.^ =
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Here
ostage
$0.47
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❑ Adult Signature Restricted Delivery $
Postage
$0,47
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3tal Postage and Fees
$6.47
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06/79/2016
Total Postage and Fees
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Dredge ❑ Fill [IBoth �] Other ❑
PS Form 3800,
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Dredge ❑ Fill ❑ Both ❑ Other ❑

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, i 'A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C Davis
Governor Director
John E. Skvarla, II
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM
Date:
!ame of Property Owner Applying for Permit: �7e of Authorized Agent for this project:
wner s Mailing Address:
lone Number)
Agent's Mailing Address:
&g(-h th-
Phone Number ( t%)
: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):
it my property located at
is certification is valid thru (date)
J-294-6
Pro erty Owner Signat
Date

AW-31-2011 1i:17A =P.OM:OIS PLAWING & INSPE 910-579-2940 TO:5794479
US MAIL
DYVISiON OF CO 6TAL MANAGENi INT
ADJACV.N'T IWARIAN P PERTY OVVNER STATEiII�-"KT
Name of Propa'ty Owrur-. (-- a 0t A d' t�
cat}
Address of Prapeety d 1m (Lotor
f)C ea n E S if ESrL?Ch
4, Street or Road, City & County)
P.2
q
Applicant's phone 1�: �l`t " ' �D I Trailing Address:
943-V 1- C760l
I hereby certify brat i own property adjacent to the i
has described to me as shoNva ea tfce at=hed dmvii
witb dimensions must be Drovided with this - letter.
I have no objections to this propnszl.
referenced property. Ttie iaidividnal applying for MLS permat
to development tbev a proposing. A descrioA ofdnim-
i iaavL objections b d?is proposal.
U you have objections to what is being proposed, y u mast 3otify the Divisive of Coastal VEAnagewent p
in writing within 20 days of receipt of Ibis notice. orrespondenex should be mailed to 127 Cardinal Drive- EA1.
Wily miggfon, ii`C 2i vd}5-3S4a s"3C i tepreseutaav csra also be ODRtitCtt4 at (91i5) ?4ti-'12&S' NQ resganse is
I urtdeastaud that-apier, doc'n, mooring pill Igs, break% ra
15, from my area of riparian access unless waived by -n
aPP?apriatebla�icbelova)
I do wish to waive the 15' set back
I do not wish to waive ft 15' set
(Fr_operty owner Information)
Sigmacnre A
Print or Type dame
Mailing address
off
6r�OVN Isle B acti, �-� �
boathouse, or lift most be set boot: a minimum distance Of
(If you wish to waive the setbaek, you must initial the
Property ,OW r uttorrmauusll-
+,T�J-k?
I'a isY or Type Name � 2
MA;lb* Address

I pE Sio-
TO:
CRRT!M2DN,a1L -rutlygxl; �-nta--Ipuagc
DIVISSIONIN OF C-0,',�STAL f-MAINAGEMEN,"T
,TY04WXjp�STA�..=T�, 117
Narne ef Froy=-y
Address of
- PrepeEty:
I h=17y cc -iffy dw I wn propen-y adjacent to the;
Ms deswtbed '.Q = aS sho�gv. auL ffie dnz6d
with dimpnsiora. mtwtLg RMdde�jd -Ait;l tilis jg�tq�-,,
1 have no 6f ,eztdons to this propos'll,
9. $trees or
efiviaNd p roperty. Tse indhddW zppEylng for thk prma-
are proposing. A 3:-.d �-In--.
bic"ttous to this Oro
Lf F 0 -er 4z v a 0 bj oc 11 i 0 ns t 0 W slat is "D c i n g pr s p os edt y u inu st. z old-,y t1h, ee D i!, 4 S; 0 n 0 f CO2. W 1W- Ek rka ge Y.1 S n C 'XZ;
im, Wr'-fing YAW-- IS days of recei-st of fibs notice. Ao IV D
'hzgtoNc 34105384&Drepwenv-1EbwtVR MMmdemn-oecned at
'W�VXM 8171C 771 10, N-1
unders"t- thatia clock, moor-Ing pilings, I rater, kqehcnas,• or lift' .rarest Toeset ba-:* a rn'Wirllusr dism"Me of
En.-nnv tpanar. accom tipless. iv?b-,td �v �.O, (If You vfish tc. Vnivo t s� areat of -v he S�t
vauii wv"', -,
I do vvish to wa;1M tho 15' set ba,.-k req4irww=-
1 E0 wish t Waive is 15' sa
,Property Owner Informatioal
Print w Type Name
MAR.-& Adlerm
Y 26., Uj
Rib *43-,
ky vir
Malt or Type,;N"Iamar-
-e
.1ing Address
T.
Print w Type Name
MAR.-& Adlerm
Y 26., Uj
Rib *43-,
ky vir
Malt or Type,;N"Iamar-
-e
.1ing Address
T.

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IF
NCDENR
orth Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat Mcerory-- Hraxion C, Ravi John E Sk irla
Governor Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM
Date:
game of Property Owner Applying for Permit: ame of Authorized Agent for this project:
G( E" ►" �! •f (�i t` � � Gl •i -- �1C W f1•1.G�1 � n
)wner's Mailing Address:
-- I YV r f t' Si
(r-t-c't vl E tydcl
'hone Number
Agent's Mailing Address:
-ZMCI, --
Phone Number (qt%)
certify that I have-auftrized 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):
or my property'located at
its certification is valid thru (date)
Pro6erty Owner sighatdr
Date

CERTIFIED MAIL • RETURN REC I� PT RfQUT END
-- C-7lVtSION OF COASTAL MANAQEMENT
ADJACENT RIPARIAN PROP RTY OWNER NOTIFICATION/WAIVER FORM
Owner: 7's
Name of nroperty O Address of Property: `d��___(Lot or Street or Road, City & Counly
Agent's Name !l `r �� W`�S_ fit- 1� br Malling Address: �1 u�".I �
Agent's phone
I hereby certify that I own property adjacent to the above referenced property. The individual applying for
this hermit has described to me as shown on the attached_drawing,the development they are proposing.
I have oo objections to This proposal. �i, pl- I have objections to this proposEtl.
if you have objections to what, is being proposed, you must notify the Division of Coastal
Management (I)CM) In writing within 10 days of receipt of this notice. Corresmpnoence. should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3846. DCM represegtooves can also be
contacted at [phone]. No response is considered the same as no objectJon ff you h1 been
notified by Certified Mail. __ c-- ---- -
WAIVER SECTION
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 requirement.
I do not wish to waive the 15' setback requirement.
(Properly Own r Inform atio�n) `I (Adjacent Property Owner Information)
1 L..�
.'ij;IK�huc'. Signani e
Print or T yp , Nalno Print or Type Name
0 ,6o)4 7393
Mailinf Address Moiling Address
City/StatelZip T City/State.,Zip 31
Telephone Number Telephone Number

CERTIFIED MAIL RETURN RECEIPT299YRES-7ED
-- WISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROP RTY OWNER NOTIFICATION/WAIVER FORM
Name of property Owner: --
Address of Property:____ _-
(L.ot or Street , S reet or Road, City & Cou(nTy- --
�S� ttilC 1'�b�" 1Q�9,-6 5W
Agent's Name #`r �� Mailing Address: C� r C
_._ Agent's phone It:
i hereby certify that I own o mesas adjacent to the above shown on the atached-drawin referenced he property.
are proposing.
this permit has described to, lrrµ_ t 21-I I)•
I have onjeations to this proposi►l,
I have no Objections to this proposal. l _
you must the Division of Coastal
!f you have obJections to what. is being Proposed, should be
otice. COrresp.9111000700-
Management piam) In writing w ithin m►da s oNCc28405-384Gt of this � DCM epres S,�Ne can also be
malled to 127 Cardinal Drive
contacted at [phone]. No response is considered the same as no ob/ect/orf !f you its beef]
"- - notifled b1 Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring of pilings,
t riparian ae water,ess boathouse
less waived by me. groin
youmust
set. bto waave� the
minimum distance of 1 � m y area
blank below.)
setback, you _mustinitial the appropriate
I do wish to waive the 15, setback requirement.
- I do not wish to waive the 15' setback requirement.
(Property Own r Information)
— djacent Property Ow er Inform tion)
i1�g..-.--
�ignafnre 4 t\ _ V, --- _ -
P►int a 1 yp3 Name Print o► Type Name
Mailing Address Malling Address c Z 0 l
l_1-� �--- - -- City/State/Zip
City/StAtt�/Zlp
%lephone Number Telephone Number

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