68099D - Lewis

CAMA / ❑ DREDGE & FILL
A B
IENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources C/ /) 7 / 12 j20
Dastal Resources Commission
, inn an area
jof environmental concern pursuant to 15A NCAC /r LiR,,ule attached.
NamP TVI i1 Jv' '1ia / �� _� Project Location: County /�^ G46'
s
Bd Agent -
❑ CW )qXW k*TA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / n� PNA yes no
ie Length L-' (-)
not sure yes n�
rium: n/a yes n
yes
r"
Attached: " yesl--Dp-
Street Address/ State Road/ Lo #(s)
v
Subdivision
ZIP 4;
City ���
Phone # () River Basin
rl
Adj. Wtr. Body L'� -�y%1 na r
Closest Maj. Wtr. Body
/i
el
(Scale: /�.
✓7
ling permit may be required by: El See note on back regarding River Basin
I ---I DL--- ;.... Ircai�-rinn\

NC ®ilvIsion OT %Mas'cal .V,-
i
Applicant:
Date: 2 S
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,
for.
FINAL. Sq, Ft.
(Anticipated final
TOTAL Peet
(Applied for.
PIN
(AN
DISTURB TYPE
(Applied
Disturbance.total
includes any
disturbance.
Excludes any
otal1 of nce
total includes •
di
Exc
Habitat Name
Choose One
anticipated
restoration
temp
any anticipated
restoration or
rest
tern
restoration or
ternim acts
and/or
impact amount
teMP irri acts)amc
w Dredge ❑
Fill ❑ Both ❑
Other
Dredge ❑ '
Fill ❑ Both. ❑
Other ❑
Dredge [j
Fill ❑ : Both .❑
Other ❑
Dredge ❑
Fill [] Both El
Other ❑
Dredge ❑
Fill ❑. Both ❑
Other ❑
Dredge ❑.
Fill ❑ : Both ❑
Other ❑
Dredge ❑
Fill 171 Both [I
Other ❑

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ale
Address of Property: I 1818 K
Is
AIc
(Lot or Street #, Street or Road, City & County)
Agent's Name#:4--)e&Jau,yP /Y\at/'wLJ Mailing Address: 1h SfA P r7
Agent's phone #: %/d - 412 - 73
nJeeson -81 ✓c
1110-,
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.
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)
�Sii1Ci#llrZ
Print or pe Name
(Adjacent Property Owner Information)
Signature
KP I-L ! c C I 1 -0
Print or Type Name
i;,,g n
Mailing Address
-7 4a Ta
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -:Yp rr-Y 44ezr
property located at
3e of Property Owner)
AAf) -5-Ur,`s,t ll0-5-AlA-
(Address, Lot, Block, Road, etc.)
on 7o�sc l Sam ��t in /3p c.._ &-
(Waterbody) (City/Town and/o County)!
// �� �� �� s ✓� (r, IT
The applicant has described to me, as shown below, the development proposed at the above locatii
have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill 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 bac
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wz
the setback, you must initial the appropriate blank below.)
12 .12 � do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop" Owner Information)
Sign ure cd
Print or 73,pe Name n
(Adjacent Property Owner Information)
Si ature
F ft r 6 L . C) a�-e � --fZEL
Print or Type Name

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner �s f S
Address of Property: H. "&60n rd. IDAser f d C, , NC
(Lot or Streets Street or Road. City & Count.c
Ageni s hla me * JD1itU a Q .)Q /ice l l o w Mailing Address: 4&1 J&A� f � •
Agent's phones 9/�- f/2 • 7�S/ wZ
I nereby certify that I owr, prcperty adjacent to the above referenced property The individual
applying for this pernn has described to me as shown on the attached drawing_the oevelopmert
they are proposing A description or drawing with dimensions mist be t)rovkf®d with this fetter
hay c no objection; to this propci,ai _ I ha% c objcction-, to this proposal.
If you have objections to what ,s bung proposed, you must notify the Divjsio.v of Coastal Management .DCMI,n
writing within 10 days of receipt of this notice Correspondence should be mailed to 127 Cardinal Drive Ert
Wilmington. NC, 2WS-384S DCM represennbves can also be contacted at 410) 7W721S. No response is
considered the same as no objection if you have been notified by Ce►tifyou Mail.
WAIVER SECTION
I understand that a pier. dock. moonng pilings, breakwater boathouse i R. or groin, must be set
back a minimum distance of 15' from my area of riparian access unless waived by me i If you
wish to waive the setback, you must initial the appropriate blank oelow.l
:�w I do wish to waive the 15' setback requirement
i do not wish to wa ve the ' _5 setback requirement
(Property Owner Information) (Adjace Pro wner Information)
!CIAn �' .Ci.e►r.rtu
-Tr,eg* Lr-<c
Pr>orlt or 1
2y 4/ ?--;a. ,
Meiling Address
Crty,'Stat
Print or Type Name
40 D
Mad/ng Address
C +4dL u TT3 /VC_ -2 IS 2'7 =1
Crtystate2x -
Telsehimin A!„rnMr
'774.1 ir 2 • v-4 z.o

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property ad,acent to atRsy Ki%Ck (Eg-4S 5
(Name of Property Owner)
property located at 1 I �8 N ���,., g1�1 �pS�►t. d�+-�
(Address, Lot,Block, Road, etc.)
(Waterbody) (City/Town and/or County)
T1e app+.cant ras described to me as shown below tree development proposed a; the above xa; on
I nave ro 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 draAing)
WAIVER SECTION
I understand that a pier clock mooring ptlirgs breakwater boatn,,)use iift. or gran must be set oath a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
Me setback. you must initial the appropriate blank below )
I do wish to waive the ? 5' setback requirement
i do not wish to waive tze 15' setback requirement
(Property Owner Information)
.nar k L.e i s
Print or ; Name
Mailing Andress
�..�._I it'd 1p?Lt!
CitylStatelZtp
9le - .?/V . C 7S9
(AdjacentKropek Owner Information)
.liuruilurc- "
Pnnt or Type 'Name ..
AJa fg ysoerl�
(1
MadAddress
r
��V W PC- 72L17—
city/sta• p
lip i- oti),-,
Telephone Number
P_ s " — i.-
Telephone Nurroer
64-- '1— .A

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1188 N. Anderson Blvd
Jerry & Vickie Lewis
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