69092D - Hill

?CAMA / --1 DREDGE & FILL P y .0
�rENERAL PERMIT Previous permit# A B
New -Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
riized by the State of North Carolina, Department of Environment and Natural Resources tt
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC [j7 it - add
❑ Rules attached.
t Name Cd W�1 jV-Y\) Project Location: County f �1.v�1s4uC
<_ u o-? Street Address/ State Road/ Lot #(s)
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❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
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f Project/ Activity !4
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2027 04:C9 PACE.
From: Ferroll, Sean C Scan.FarrclWC nctl'.+nr,gnv d
bleat: FW: Bond data from MFP1160788?. 04/1W2017 12:14
Date: April 17, 2017 at 12:14 PM
To: [e-mail]
Cc= wc�idooke;idAol.CUM
solyn,
looped to the General Permlt for the Iloatinll dock and let dock. Please note that the new docks Please say not ign tabs attactd the 14 pet mot and scan
f Irls
Iterbody, approximately 85' from Marsh Ed:Me, nor shall their combined area exceed 400 sq. tt g
ICk as Soon as possible for processing. Cot lact me wlth any qucvtlone,
ranks,
can Farrell
leld Representative
lvlslon of Coatztal Management
',orth Carolina Department of Environments Quality
10 796 7424 office
,ean.Farrell@ncdenrgov
27 Cardinal Drive Ext
Vllmington, NO 26405
°mall correspondence to and from thle additaee is subject to the
lorth Carolina Puoft Records Law and may be disclosed to third parties.
••••0riglnal Message ----
From: NCDEO • Wilmington Regional Office Scanner CAMA (mallto:DoNotRepiy®ncdenr.gov)
Sent: Monday, April 17, 2017 12:14 PM
To: Farrell, Sean C <Sean,FarreA(oncdenvi.OV>
Subject: Bond data from MFP11807982 04: 1712017 12:14
Scanned from MFP11807802
D ato' 04/17/2017 12:14
Pages:11
Reeolution:200x200 DPI
HAVE A GREAT DAY"'
E-mail correspondence to and from this address may be sub)ectto the North Carollne Public Records Lew and may be disclosed to third
parties.
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
11�� 1 Pit ##: q
Applicant: COt;�O ��✓� Permit �� I � —f)
Date:6'11CIA611
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/o.
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

1
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: d.-&4(466j 2�zl�
Mailing Address: / 7 l�i� 1 alp
-S14 //)#e-- iVC-
Phone Number: 7S_5-- Kg7' r
Email Address:
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at —4
in County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
}
Title

1�
I hereby certify that I own property adjacent to
I
I (N a of wrp e U ne
property located at —� U � fUi pJu o-rd P�. �w ; �0- C � L
n (Address, Lot, Block, Roo , etc.) ��pp
on \ �, i I ��� 0-n C r-ee�_ in �rarLs t� �(G� (�0c1 , N. C.
F(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locati
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bp -
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w,
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.
(Property Owner Information)
(Adjacent Property Owner Information)
A.::
Si ture
Print or e arn e

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or
Mailing Address:
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 or drawing with dimensions must be provided 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 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, 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.
(Property,Owner Information)
VA it) :L&�c .1 2 LJ —
ature
Print or Type Name
-7 c�7,5 G� 1.
Mailing Address T_ `
(Adjacent Property Owner Inform tion)
a•
Print or Type Name "
Ian -L 41 ..1!
Mailing Address
1 A _ ALL 11 -sr

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