67285D - Morris

] C; sAMA / ❑ DREDGE & FILL
;ENERAL PERMIT
*ew []Modification El Complete Reissue
[]Partial Reissue
A
Previous permit #
Date previous permit issued
B
-ized by the State of North Carolina, Department of Environment and Natural Resources 1
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC H.
0 ❑ Rules attached.
1 Q' - o1 %' W.�,_� �
t Name o Project Location: County t:L 4—
bi e- Street Address/ State Road/ Lot #(s)
NA StatetO ZIP
E-Mail _ Subdivision
ed Agent /` City I ZIP Vi
❑ CW EW kTA ❑ ES ❑ PTS Phone # rl
( ) River Basin /A
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A c - ` I
❑ PWS. Adj. Wtr. Body �/�_j, (nat
yes no PNA yes�i no Closest Maj. Wtr. Body �Uti W
Project/ Activity 1 t cmc V �\( A ky, 0 '1"o w&r i 1)Si vy- A
:k) length L 1
xform(s) I X
Platform(s)
er(s)
igth
nber
1/ Riprap length
distance offshor
K distance offish e
annel
,ic yards
Length
,[lathed:
(Scale:
I11 Z
ig permit may be required by:
focal Planning Jurisdiction) 1\ ,
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❑ See note on backregardingRiver Basin rt�
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DCM WILMINGTON,
J U N 2 6 �017
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APPLICATION:
"i
ITO
UXALITY: _-- -- PERMt EH 0' SlAy E D
STi4'7N, I
YES NO
JUN 2 6 2017
E _°c
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
■ Print ygur name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. cl Addressed to:
�r� tS c I -xi �ll1 �h,�f-rc r•.
A. Sig e
X Agent
❑ Addressee
B. Received by (Printed Na ) o etivery
/ 7
D. is delivery address different fr* item 171 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type -
N' C
P Certified Mar
0 Priority Mail Express'
1
2-7 4-©5 - e 1 7
13 Registered
® Return Receipt for Merchandise v
RE
f
❑ Insured Mall
E3 Collect on Delivery
4. Restricted Delivery?
a
(Extra Fee) © Yes
d2. Article Number 7016
(Transfer from service label)
2140 0000 0834
7405' W
PS Form 3811, July 2013 Domestic Return Receipt
■ Complete items 1, 2, and 3. Also complete
A. SquAWr
/
item 4 if Restricted Delivery is desired.
❑Agent
■ Print your name and address on the reverse
❑ Addressee
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
B elved by nted Name)
C. Date of Delivery
or on the front if space permits.
icifr?2 R"Z t._-
1. Article Addressed to:
�I(�-Rt Gi.t��l a, 4,� l—
D. Is del' L1Xre m item 1? 11 Yes
If adare w: ❑ No
sua
MAR 14 20i
jj
rc�
�a,ype
. � Mail'
Z72, 3
� ,
Mall ❑ Coil on Delivery
4. Restrlo Fee)
0 Yes
2. Article Number (7 016 2140 DODO 0834 7399
Transfer from service label)
PS Form 3811, July 2013 Domestic Return Receipt
1�
arr —

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DCM WILMINGTON.
JUN 2 6 2017
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWLAIVER FORM
Name of Property Owner, rLao & and -5 he aria
Address of Property: Il f '—� 134t7—� -�9wet, a, 0 6 %r)d k (' z t 4 L s
(Lot or Street #, Street or Road, City & County) C RIPL j
Agent's Name #: ,� Lt t t W d I S Ertl. Mailing Address: 5-0 � es OLO-pj kd.
Agent's phone #: qIC , Z�14- /4&3 Q r6),0nS A1G G l46S -C / 7
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)
Signature
C-11 .ha(t i -16rrIs
Print or Type Name
�i l 1
Mailing Address
61L 2-737/
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address

iE(- _WED
DUVI WILMINGTON,
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION jA 2 b 2017
Name of Property Owner Requesting Permit: Per�500
Mailing Address:
_lroU, A(C 27.371
Phone Number: 42 - �� —
Email Address: t," d� `�h , /v hf ac k . CDm
I certify that I have authorized (,( Lt.( lder!� - / nC
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 /0 C( 4- ,C 34 t' 54reel Ca k- / Skzne N�
in ruit7 iv ii c-L County.
f furthermore certify that / 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:
c C fl
S" nature
Tk-tU tT /G U ffM4U' !� OAP 6
Print or T pe Name
d e. ,u G CZ -
Title

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date:(✓ ` ` /
Describe below H� fTA�f 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
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount
temp impacts)
amount)
V v
Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑