69372D - Spivey

'toM❑ <6AA7 DREDGE & FILL f1A B
3ENERAL PERMIT Previous permit#
(New ❑''Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_
-ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commissigp in an area of environmental concern pursuant to I SA NCAC
n �e
J
s
❑ Rules attached.
t Name
I
Project Location: County J�,A� LAA
Street Address/ State Road/ #(s)
. j o�
State ,Soo"
+Lot
5 Z rO n (O (8 s7 -
(t1Q) 40_ "Z E-Mail
Subdivision—'"—V"`
ed Agent
� O i (.
(Aky\,t
City Oct V, �S�Z i'Cy i^ ZIP-1-g y
ElCW
YEW -1-4rA ❑ ES
ElPTS
one �r# (10 ) � g 12 River Basin L u
❑ OEA
❑ HHF ❑ IH ❑ UBA
❑ N/A
Adj. Wtr. Body � V, (nat h
❑ PWS:
Closest Maj. Wtr. Body— —, t —1 �� ✓ 4—
yes /�n�
PNA yes / rryo
(Scale: _
ngth
mber
d/ Riprap length
distance offshc
uc distance offsf
1
cannel i
bic
np
ise/
ulldozing
vanma
ie Length (]
not sure yes "10-,
-ium: n/a yes o v '"
yes o i _
Attached: no
V �' es � jj;; r'
ing permit may be required by: Tow o D � V `c 0, VA � � D t� (►'` ❑ See note on back regarding River Basin i

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIB OA TLIFTIB OA THO USE)
I hereby certify that I own property adjacent to B t k i is
(Name of Property Ow er)
property located at 52 C ors co r d lzs�
(Lot, Block, Road, etc.)
on 0-13-ncj , in 0 Cec..,,, is Imo. J, , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: a/0 —4,qo - Mailing Address: 5.a. Q-,Qncor-L-. --SE
1�) cia', m tc— Y1C--
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boallift / boathouse
must be set back a minimum distance of fifteen feet (I Y) 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 not wish to waive
do wish to waive that setback requirement.
-----------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
-5�z _Co INcof-A 5-�-
Mailing Address
--------------------------------------------------------
(Riparian Property Owner Information)
- Z /-,
Signature
Oc, . = k� l L `ll C
NOLAes Grp n

US MAIL
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
e
Address of Property: SoQ 0xw)s-o(-Q- tea,--, Tsle� &acL nL
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: 9/0 & 4D.- 7.2Z
Mailing Address: ,s Q Ck),nCA�-r l s+ • _
es-,n fie_ k-Qc -L- 'IAC—
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this perm
has described to me as shown on the attached drawing the development they are proposing. A description of drawin
with dimensions, must be provided with this letter.
It- r 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 Ex
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, clock, mooring pilings, breakwater, boathouse,. or lift must be set back a minimum distance c
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' set back requirement.
(Prope I` 0 er I or tion)
Signature
Print or Type Name
s� a u,r< cAr_j
(Riparian Property O ner Information)
--
Signature
Print or Type Name 13p �l
inz
inQ
Mailing Address
Mailing Address
rAQ Al C � '

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date �� 9— / 7
Name of Property Owner Applying for Permit:
I ,1Ct S
Mailing Address:
Sa Caml
oc.c",
I certify that I have authorized (agent) W k ,c, c , .. a to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) Sal C� nc r c 5 �-, U ce r.,,. isle
This certification is valid thru (date)c k�
Property Owner Signature(/ v Date