69031D - San Miguel

CAMA / '�'DREDGE & FILL
ENERAL PERMIT 3 Previous permit# _)
(New Li Modification ❑Complete Reissue ❑ Partial Reissue Date previous permit issued � I -
)rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC VJ 0 s: ` I2-0fJ
�a ❑ ules attached.
it Name l l � P N j�1/1 1 �••l% & L -- Project Location: County
fyt 5 1n1
I�3 �T ✓L�t ) f-'16 Street Address/ State Road/ Lot #(s)
x'OZI A 4�urAA State NG• ZIP 2?4-66 '
�?In )LU -� � E-Mail Subdivision
zed Agent
NIN
❑ CW
'i�J EW `Q PTA %X ES ❑ PTS
❑ OEA
❑ PWS:
❑ HHF ❑ IH ❑ UBA ❑ N/A
yes Ctfil)
PNA (Liv no V
City c� e�4S ZIP 2 25Q
Phone # ( ) River Basin WIM f
Adj. Wtr. Body _ �(a n
Closest Maj. Wtr. Body `5TUA fl' u LN1�
f Project/ Activity tx' kz'�_ >sl {V q v d V E - If, S4 u
)ck) length LO X, c) �C
mgth \
amber
idi•Fjjprap length # 9
g distance offshore_ _
ax distance offshore
hannel
ibic yards
,np
ozing
ie Length -f 1
not sure yes _o
•ium: n/a yes ` no)
yes
Attached: ; ", yes
%nol
6!(lew Ca—.
(Scale: i1':2
ng permit may be required by:
Local Planning lurisdiction)
❑ See note on back regarding River Basin r

NC Division of Coastal:Mgt. Habitat impact-CoMplator Sheet
phcant
te:
scribe below the HABITAT disturbances for the application.
fat code sheet
values should thatch the name,.and units of measurement found in. your
Hab�
TOTAL Sy: _Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fins
DISTURB TYPE Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes ,
di turbance.
Excludes any
�bitat Name Choose One anticipated
restoration
any anticipated
restoration and/
"rmnA
restoration or
and/or temp
restoration or
temp impact
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 171
Fill ❑
Both ❑T
Other ❑'
Da
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
�JJ
Mailing Address: t 3 J f r J L
S ✓y 3 0�3>S i ✓L �%, i�l C Z [�y
Phone Number: D
Email Address: G M R (Z— C 0 ./V-I
I certify that I have authorized (ty (�L �� (�'� J (Z 6 'q I'-)
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 3 J S /ivL ?Teti
in O V S LL w County.
Z�ye�
1 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 Ow r Infor ation:
I S 0)
Print or Type Name
1�
Title
2 _ li7 nni l

12/27/2017 06:39 2159687825 OPVANTEK
0022/2008 02, 20 910?257078 (3(L- 2ER
i7eI41���
PAcaE a2e'64
CERTIF19D MAIL • RETURN RECEIPT REQUE5TED
DIVISION OF COASTAL, MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWGN-E, R NOTIFICATION/WAIVER FORM
Name of Property Owner;
1 Z.. C' I N bt - ?� s) �rU tJiU St L
Address of Prepnrty, /
(Lot or Street #, Street or Road, City & Gaunty)
Agent's Name #; Mailing Address: 6 -
Agant'5 phone /4 10t
I hereby certify that I own property adjaCen; to the above referenced property, The indivicivai
applying for this permit has described to me ?s shown on the, attached drawing the development
they are proposing. A�scri t�ior o� rawlna, with dimensions must be provided_with this left
i havc no objections to this proposal, I have objections to this proposal.
if you have objections to what is bein_q proposed, you must notify the D111IMn of Coastal hfanagAment(DCM) In
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 20405.3845, DCM rApresentatives Can a150"r-ontactedat (910) 79&721s. No response is
considered (be same as no objoctfon if you have been nottfted by Certiffed MaH.
WAIVER SECTION
I understand that a pier, daak, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of IS' from my area of riparian access unless waived by m(-. (if you
wish to waive the setback, you must_in't� the appropriate blank below,)
, , _i- 1 do wish to waive the 15setback requirement.
I do not wish to waive the 15' setback requirement,
ropy Owner —fA Infnrttt�tlon
t,
Print or Type Name
Mailing Address
Signature
Pri t or Type N, me
t vl
Mailing Address

2/27/2017 06:39 2159687825 0PVANTEK PAGE 02!1
FAT_�E 01/04
04/22/2008 02:20 9103257073
f�COKR
ADJACtrh1T R;P IAN PRC)P�RTY OWN ST TEMENT
Z-G*.G' t., 'a
I hereby certify that i own property adjacent to �� —
Name of Pry Owner)
properly located at t '�,_� J'��G�
(Address, Lot, B1oak, Road, etc.)
in
..� i �.� Fc.�� . N U N.C.
on i er%
(1Natrbo+dy) (GitylTown .7ndior Cour+ty}
The applicant has described to me, as shown below, the developrnent proposed at the above location,
I have no objection to this proposal.
I have objections to this propasai.
pESC sing d veld moat mR qt till n deserfpt on bG OF elow or attach DEVELOPMENT s to drawing)
(individual proposing P
5 0-
WAIVfrF-S CTIO
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
Zyou must initial the appropriate blank below.)
t do wish to waive the 15, setback requirement
I do not wish to waive the 15' setbarrk requirerne
Owner lnf^ation)
A n'
Print or Type N rn `S�
�airi �� ���y l✓���,r�
information)
'z C-
Signature
Print r % k' 1rtB y
Mill n Addnsss %� j 7

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: i Al `%,} `77 All "e_�, /
Address of Property: / 3 ��� i��/,� �� ,c/ jyL
(Lot or Street #, eet or Road, City & County)
Agent's Name #: Mailing Address: /v? 7 -I-,'A)
Agent's phone #:
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.
t 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.
roperty Owner Information
Print or Type Name
1 -3 S, Nrjz-;
(Adjacent Property Owner Information)
J a,
SiRnalure
Print or Type Name
, ,f
Mailing Address
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _�= �5,�}�.t n1/yGc� L I
property located at - (Name of Propert Owner� NG
�, ( dress, Lot, Block, Road, etc.)
on �1 lam/ t✓ q �.Z ('fit C.0 inS�/� %�� S F�.C�y,�/�► c. N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
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)
5-'g�- JofpL✓,�C.
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.)
-"_k?2 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(wjope own41nfation)
7 SNM�a�rcL
Print or Type N
'amg ?�'� S, t
(Adjacent Property Owner Information)
Signature
Print or Type Name
aniti%3+'n�� ,aq' �ddress
Mai�qg Address

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