69127D - Stanley

CAMA / ❑ DREDGE & FILL -� \"1 A B
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources -? 1
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f � Oo Rules attached.
Name vk" k
/\/ p� /n'A C"' State_ ZIP Il
(ft) MQ" 1 E-Mail ed Agent V n-(t (f 211Aj­ VV(
❑ CW ❑DXTA ❑ ES ❑ PTS
❑ pEA ❑ HHF H ❑ UBA ❑ N/A
El PWS:
yes / fio PNA yes /
Project/ Activity
ck)length
atform(s)
Platform(s) 5( )d G
;ngth
tuber
A/ Riprap length
g distance offs
ax distance 9f(sF
hannel /
i Kyards
mp
use/ FO
3ulldozing
A" L
ne Length V
not sure yes I"
)rium: n/a yes
yes 10
Attached: & no
Project Location: County Snn�_
Street Address/ State Road/ Lot #(s)
,21Q MGn0-f S�
Subdivision
ZIP
City aN �'�' G [l'l
Phone # (�i t 7 River Basin [ lNN
Adj. Wtr. Body A V1 M nat
Closest Maj. Wtr. Body /' ' LAA—
(Scale: (`-- '(
Jing permit may be required by:
❑ See note on back regarding River Basin

to items 1, 2, and 3.
ur name and address on the reverse -
we can return the card to you,
this card to the back of the mailpiece,
to front if space permits.
,ddressed to:
N-,e A ro2,556�
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Re iv ✓✓��b--y (y rin"tted Name) C. Date of Delivery
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D. is delivery address diff rent om item below:
No
If YES, enter delivery address
0 Priority Mail Express®
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❑ Adult Signature ❑ Registered
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III'I ❑ Certified Mail® ❑ Return Receipt for
0603 5183 4331 00 ❑ Certified Mail Restricted Delivery Merchandise
590 9403 ❑ Collect on Delivery ❑ CO nfirmationT"
- ^ i Delivery Restricted Delivery Signature Confirmation
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Domestic Return Receipt ;
n 3811, April 2015 PSN 7530-02-000-9053
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NC Division of Coastal Mgt. Habitat Impact Coml
Applicant:
Date: m /0�
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.
FINAL Sq. Ft.
TOTAL Feet
F11
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex(
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
temp impacts
impact amount
temp impacts
am
I
4 V)
Dredge ❑ Fill ❑ Both ❑ Other
a —7
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑

NCDEE R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton C. Davis
Governor Director
AGENT AUTHORIZATION FORM
Date: , ;
John E. Skvarla, III
Secretary
im of e Prope Owner Applying for Permit: N of Aut(Porriize ent f r this project:
GLJ�1C,1� W`1�CIy�
Nner's Mailing Address:
�L? v S eelev cl-Lele Ks )%Vey
� , C , .? s us S
lone Number (WA 6 9-0.3 U
A nt's Ma' ' g Ad res
1b,
CSC
�<6-L�(�
Phone Number tU oq S
:ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
al
>r my property located at �:)b r t 16 (�
i9t the following (activity):
'\its certification is valid thru (date) 6J Cz, oe � a r\
,n
Property Owner Signa Date —

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIP IAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. t1 `� nl-m1
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #:G Q C 'V'CA'( C TtUr7 mn
ddress: l0 J ech bi,—So
Agent's phone #: %6 -S14- 6RS- J e Qd) W 00 l6 i
1 hereby certify that I own property adjacent to the above referenced property. The individual applying for
is. permit has described to me as shown on the attached drawinq the development they are proposing.
I have no objectionss to this proposal. _ I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Divi of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Co, "Ice should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representiII11*1106 can also be
contacted at [phone]. No response is considered the same as no objection M`ytli'r 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 1 formation)
�_ e ,
nature
0 n
Print or Type Name
111M a\R
Mailing Address
�kl(trvu �( zS
City/State/Zip
rlq.\ I r rr, r* ,
(Adjacent Property Owner Information)
Signature
��(,rK Sy�ngos
Print or Type Name
� 3 Vedra b -
Mailing Address
�a r b o u r- s✓ j 12� W V
City/State/Zip

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
) r 1�.,, '
Name of Property Owner: (1 ` ►"�4�I
Address of Property:yCS U--W, C4-Cx n .1-5Q i�W (Y)
(Lot or Street #, S reet or Road, City & County) Agent's Name#: lCQ W '�An1� UO M cling Address: o J (1) Or -SO
Agent's phone#: � �-S��-q�� t, Q CFU] -Z0vY
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 drawin the development they are proposing.
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 D/v/ n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Comes a should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represenfid* can also be
contacted at [phone]. No response Is considered the same as no objection h'y'i"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 1 formation) (Adjacent Pr rt Owner Information)
" A�A%
— e
nature LSignature
U\ n V V "4e I�5 S
Print or Type Name Print or Type Name
Mailing Address Mailing Add ss
rp ZS C ,
City/State2ip City/State/Zip

21/2012 21:36 9105799096 GRICE CON PAGE 0
DIVISION OF COASTAL N
ADJACENT RIPARIAN PROPERTY OWNER
Name of Property Owner: `�� ��q r\
Address of Propertyg mt) rn)7p
AGEMENT
iTIFICATIONIWAIVER FORM
(� (Lot or Street #, Str4et'oJRad, City 8 County)Agent's Name li: (Q`����CS��7l� r�''(�,� (Iv� Address-
Agent's phone # _ 1lC S l (I" C
titIiiiii;,,— n
�h 0r 5u,
I hereby certify that I own property adjacent to the above rel brenced property. The individual applying for
this permit has described to me as shown on the attached c awing the development they are proposing,
A descri Lion or drawing, with dimensions m st be provioed vith this letter.
have no obiectioos (o this proposal. I have octions ro this proposal.
!1 you have objections to what is being proposed, u must notify the Division of Coastal
e
Management (DCM) in writing within 10 days of racelpt this notice. Correspondence should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 2940 3845. DCM representatives can also be
contacted at [phone]. No response is considered a same as no objection if you have been
notified b Certiflod Mail.
WAIVER SECTIO
I understand that a pier, dock, mooring pilings, breakwater, bcathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unl s waived by me, (If you wish to waive the
setba(;k, you must Initial the appropriate blank below.)
1 do wish to waive the 15' setback requiremen
I do not wish to waive the 1 S' setback requirement.
(Property Owner Information)
turrrre
Print or Type Name
Mailing Address
e"
Pr
nt Property Owner Information)
lam. , Tzx<
Type Name
,54 i ` ?'
I Address
City/State/Zip
r%,% . I r . . - r'1. '7 1