69334D - Pociask

CAMA / I DREDGE & FILL y/5 Jo
iENERAL PERMIT
New ❑Modification L -1Complete Reissue El Partial Reissue
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC_
Name �i 1 VO (� Ci S k- Project Location
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Previous permit #
Date previous permit issued_
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❑ Rules attached.
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Street Address/ State Road/ Lot #(s)
State
ZIP
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Subdivision
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City a iA f' u V I ZI❑
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❑ PTS
Phone# ( ) River Basin❑
OEA ❑ HHF
H ❑ UBA
❑ N/A
❑ PWS:
fes / f% PNA yes /
Project/ Activity ,
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tform(s)
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gth
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/ Riprap length
distance offshor
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Adj. vvtr. Body (nat
Closest Maj. Wtr. Body JAI
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(Scale:
❑ See note on back regarding River Basin ru

■ Complete items 1, 2, and 3.
■ Print your 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. Article Addressed to:
4VVVL— N)r'�' so�Al, QS
IIIIII I�IIIIIIIIIIIIIII III'IIIIII �II IIII
9590 9402 2218 6193 9338 03
2. Article Number (Transfer from service labep
7017 0660 0000 7486
PS Form 3811, July 2015 PSN 7530-02-000-9053
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■ Complete items 1, 2, and 3.
■ Print your 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. Article Addressed to:
20�O9020�
A. Signature N N tJ N
NJN rJ hiN
�% / Agent 0 0 0 0 0
X / ley" ❑ Addressee
B. Received (Printed Name) C. Date of Deliver
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D. Is delivery address different from item 17 ❑ Yes
If YES, enter delivery address below: W11
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3. Service Type
❑ Priority Mail Express®
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❑ Adult Signature
❑ Registered MaiITM
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❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
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❑ Certified Mail Restricted Delivery =�I
Delivery
Re Receipt for
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1-1Collecton Delivery
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Merchandise
Signature ConfirmationTM
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❑ Collect on Delivery Restricted Delivery
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❑ Signature Confirmation
7689 rioted Delivery
Restricted Delivery
Domestic Return Receipt
A. Signature
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❑ Agent
X v `' "�(4 ❑ Addressee
B. Rece ed by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 19 ❑ Yes
if YFS- enter delivery address below: ❑ No

-;01`
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN �P,Rf`OPERTaI--OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner'.
Address of Property: �2 OCU `1T5A
(Lot or Street #, Street or R6ad, City & County)
Agent's Name #: r icytru—il'� Mailing Address:CO�Ch ► J('
Agent's phone #: % 095 0!w1n:Z�5tQ Mill N(
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 ero i_y �Md.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 representadves can also be
contacted at [phone]. No response is considered the same as no objection lfyo7'HI(Eve 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
Print or -Aype Name
�`Q 3 'R)r4 0-
Mailing Address
�'va (,-1� � N� ( 2�Z�
City/State/Zip
i t
(Adjacent Property O ner Information)
igna ure Z Ly i�v
sI'lr /,/
Print or Type Name
?2-2-1 C/
Mailin ddress
City/State/Zip

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTYO NUER NOTIFICATION/WAIVER FORM
Name of Property Owner: e ��sz �1 �G C- `�l5
Address of Property: �� ���� �7� 1 j � gT5k-dmC:Q�f 1
(Lot or Street #, Street or Rbad, City & County)�U t t�
Agent's Name #: G r +ct �s�ruL�lU� Mailing Address:" � � 1
Agent's phone #: %r,)_ IL 2- 6% i
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 r t*§ 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 Divis/gn of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. CorresponAmce 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.)
vV�
//,�� ,� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or -Aype Name
�\A_] \3 ?)n(_Y
Mailing Address
(�o k R 2 S Z-17
City/State/Zip
(Adjacent Property Owner Information)
.Si nUIure
Print or Type Name
Mailing Address
City/State/Zip

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! Domestic Mail Only
For delivery information, visit our website at•
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Certified Mail Fee
$ IS
Extra Services 8 Fees (check box, add tee re)
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❑ Retum Receipt (hardcopy) S I- •
❑ Return Receipt (electronic) $ i ! _ I ! I I Postmark
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[:]certified Melt Restricted DeRvery s I;', Q Here
❑ Adult signature Required $
❑ Aden signature Restricted Delivery $
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Postage $ t • 49
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Total Postage and Fees 06/21/2u1-
$6..:
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$
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NCDENR
North Carolina Department of Environment and
Division of Coastal Management
McCrory Braxton C. Davis
)vemor Director
Natural Resources
John E. Skvarla,
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FURM
Date:
ie of Property Owner Applying for Permit:
P06N ILrC AIL
ier's Mailing Address:
71� "URCH Ct
HA-P- LQ'-�E f I1 G
Zk��-7 -7
ne Number 10546 IN f
Name of Authorized Agent for this project:
Agent's Mailing Address:
(� l01 �' ,8��1-fit ��' • -Ski/
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Phone Number-lL—v►�q
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
nd obtaining all YAMA Permits necessary to install or construct the following (activity):
t�>oGK �r L�,nA�--IwG 4oGk
my property located at 2-5- DCCAA) IS L-5
NL 2�L
certification is valid thru (date) o Pi3N u) 0 Pt' 6 u CoF
Property Owner Signature Date