69126D - Lambert

(QWA / - DREDGE & FILL ` i�n` A B
ENERAL PERMIT Previous permit# —
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 11d T
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC V
❑ Rules attached.
It Name 1 A Jr . Project Location: County (K)W!�yA cK
1 State�ZIPS
(' ) NVI 5q ` S E-Mail j
:ed Agent �%% a �J J��e �� l / (,Y '0
❑ CW PTA ❑ ES ❑ PTS
❑ OEA HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes /(9 PNA yes /
f Project/ Activity
ock) length
latform(s)
Platform(s) COL
mgth
amber
id/ Riprap length_
g distance offshore
ax distance offs
hannel
mp
ie Length
not sure yes ro�
rium: n/a yes
yes
Street Address/ Stag Road/ Lot #(s)
Subdivision
cityhC h L� j ( N rA ZIP
Phone # ( ) " 8 Ou ver Basin LVO
Adj. Wtr. Body Jnat
Closest Maj. Wtr. Body
M
(Scale: !' , ;
Attached: yes (ISM 1 1 1 1 I 1 1 1 71 L1 T 1 I/ 1�^1 1 i I I I I I I I I I . I I i I I F i I I i
ing permit may be required by: ((Q 1. T�%� V , 1 ❑ See note on back regarding River Basin
1 ­1 Phnnina It ricArtinn) n A

■ Complete items 1, 2, and 3. �'AWVIISPIikddressee
Si at '
■ Print your name and address on the reverse
El Agent
so that we can return the card to you. cri
■ Attach this card to the back of the mailpiece, B. ved by (Printed Name) C. i1i5aNp of Delivery N
or on the front if space permits. CD
1. Article tAssed �: r D. Is delivery address different from item 1? El Yes J
CCU`•-il If YES, enter delivery address below: ❑ No
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II I IIIIII III) III I I I I I I I I III II I II IIII I II III I III 3. Service Type ❑ priority Mail Express
❑ Adult Signature El Registered Mail- �
❑ Adult Signature Restricted Delivery 1-1RegisteredMail Restricted
9590 9403 0603 5183 4330 87 rtified Mail® Delivery n
Cl Certified Mail Restricted Delivery .162Veturn Receipt for O
❑ Collect on Delivery Merchandise 75
❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation-
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2. Article Number (transfer from service label) ry ry
- -- - Signature Confirmation �
7 016 0600 0000 8200 4624 Restricted Delivery Restricted Delivery
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PS Form 3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receipt
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•ER: COMPLETE THIS SECTION• • ON DELIVERY CT
cu
■ Complete items 1, 2, and 3. A. 7
re
■ Print your name and address on the reverse X ❑ Agent
� v
so that we can return the card to you. ❑ Addressee
■ Attach this card to the back of the mailpiece, B. eived by (PtLrintetne) C. Date f Delivery
or on the front if space permits. dst ^ l 1`(.Q 5 /17
1. A Icle Addressed to: D. Is delivery address different from item 1? Yes
O 1�Yti `� rn� If YES, enter delivery address below: ❑ No cc)
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Qo
II I IIIIII IIII III I I I I I I I I III II I II IIII I III I II III ❑ dullType Signature Priority Registered Mail- ss�
Adult Signature Restricted Delivery ❑ Registered Mail Restricted
9590 9403 0603 5183 4330 94 ❑ ified Mail@ Delivery
Certified Mail Restricted Delivery r.�urn Receipt for
❑ Collect on Delivery Merchandise
2. Articlp Ni imhpr (rransfer from Service label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation— —'
❑ Signature Confirmation
7 016 0 6 0 0 0000 8200 4 617 icted Delivery Restricted Delivery
N
'S Form 3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receipt
CD
-
ostal ServiceTM U.S. Postal Service.M -
IPIED MAIL" RECEIPT CERTIFIED MAIL° RECEIPT
Domestic Mail Only •
is Mail Only •
ery information, visit our website at www.usps.com°.
ED Certified Mail F-ee
For delivery information, visit our website at www.usps.com •
•

A -
—AMEN
EEN
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton C. Davis
Governor Director
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date: •90 J7
ame of Property Owner Applying for Permit: Ia of Au orizecl Age�t for this project:
Ford
'�•, �arrb�r� �• �\ ��1S�ClkLl ���1
wner's Mailing Address:
--
,�c, A 13 os
lone Number f %15 �_ t f ff %9J isr,G
9 /0 - &910.- "o ff ced/
A�Qt\ O a/-Cr l Address:`��
SW
cZ<6 q
Phone Number &)
:ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
r and obtaining all CAMA,Permit� necessary to instaltor construct the following (activity):
�T
Dr my property located at
its certification is valid thru (date)
Property Owner Signature Date

i
L
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY
OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. J �v)_O VJA m 4�c C
Address of Property:
(Lot or Street #, Street
Agent's Name
Agent's phone #: �Ll J_� `l O Rs
or Road, City & County)
Mailing Ad r ss:
�,f
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 descrOpen 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
ihave 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 representativ,Ps can also be
contacted at [phone]. No response is considered the same as no objection it yaa A*" 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, fpu must initial the appropriate blank below.)
7
ot 'l? I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr perty Owne I ormation)
_h"
S' nature
Print or Type Name
Cku ekj �I I P N (2 M5--
r",;, , •-,I I —._AII
oy'r 6perty Owner Information)
Signature
Print or Type Name
toq r io m,", VA�
Mailing Address
City/State2ip

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY
OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. Nj'-O �a O , K C-
Address of Property: L \ l A � V6rC 15�z C)C—e(4 n T-15 �2
(Lot or Street #, Street or Road, City & County)
Agent's Name #: �S� �6�6 \ Mailing AIs
s: l!� I 3Q C f (6—sbj
Agent's phone #: t�j� -1 l
q (\ A/j Qd) W ;,, ,�
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.
(-""TI L 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 Divisjon 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 representativ" 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.
(Pr perty OwneK Information)
NA j -gcged
il naruie �
Print or Te Name -
II
(Adjacent Property Qwner Information)
Print or Type Name
i� � LIQ A,�, 0 \, x \) � - -
Marling Address
Cdty tate/Zip

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