69429D VanCampen

CAMA'l ]DREDGE & FILL I/�a l 1 n A B
'ENERAL PERMIT 5 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 0
1 - f1r^
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC t t Yt/�` }
❑+Rutles attached.
t Name �(A O N ( t rk VA o (all_ t J)fL- Project Location: County �� � j�1r 1-1 a. �i ov- r
t-2` uy L- "2 Street Address/ State Road/ Lot #(s)
4- ) State &—!L ZIP 2 �`t% (. �� ►� �� O t
O 1 Cr 9. t!( LE -Mail Subdivision
ed Agent st-� W n (cO Lk& 1 City w I {� t 111�1�� i ZIP_2
❑ CW [YEW PTA ❑ ES ❑ PTS r '�f hone # (I J 9 11 River Basin CG(
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body A' U I (` t j t) 0l 'hb S (l.1 l t J gt:t
❑ PWS: f ! (,ti (/y
-� Closest Maj. Wtr. Body
yes /' no f s PNA / no
F Project/ Activity ' 'v1 ((/l 1 L IN 1 j x:111 1►1 of l
(Scale: �I1=
ick) length_
latform(s) _
Platform(s)
imbength
ember
id/ Riprap length_
,g distance offshore_
ax distance offshore
:hannel
abic yards
mp
use oatli
r
Bulldozing
1 f.i1
t.,—
ine Length
not sure
yes
4VO
)rium: n
yes
no
_.
,.
yes
/\
ho
r Attached:
yes
ding permit may be required by:
(_ b _ ❑ See note on back regarding River Basin

HCDEHR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
ly Eaves Perdue James H. Gregson Dee Freeman
mor
Director Secretary
AGENT AUTHORIZATION FORM
Date: —
of property Owner Applying for Permit:
.es Mailing Address:
Name of Authorized Agent for this project:
hl �i., .elcf
Agent's Mailing Address:
��aTwlT.�
2Fya %
ie Number ( 1 _
P91 .Number �'/AD -q`3
fify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying
ind obtaining all CAMA Permits necessary to install or construct the following (activity):
property located) at 2-0( 1��'
rtification is valid thru (date)
��-9
Property Owner ignature Date

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEM N T
Name of Property Owner: f /I( yati ,Dell
Address of Property: C( :Ta le4- 11\ j ,
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:
Q( c -2 (9 �— ((v (
Mailing Address: / 2, a 6Ox / 20 Z
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this perr
has described to me as shownon the attached drawing the development they are proposing_ A description of drawir
with dirriens' s must be provided with this letter.
f 1 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 (DC1VJ
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive K
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
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(trope Owner Im
0�1N,
Signature
Print or Type Name
D, 6&x (2 027
Mailing Address
City / State / tip
Telephone Number (^ /(o
(Riparian Property Owner Information)
Signature C
Print or Type Name
Mailing Address
IN(( IlMtr,� ; �!� z6tlo
City / State / Zip ()
Telephone Number Ch U ` ' -7 l ` 1 1 9

c�THUD MAIL - RETIIRN REcEIPT REoUESTED
Di VISA OF COASTAL MAINAGEWNT
ADJACENT RIPARL*,N PROPERTY OWNER STATEMEpt^T
Name of Property owoer:
Address of Property: ��a ( 1'c1!/tl
(I.ot or Street #, Street or Road, City & County)
Applicant's phone #: Q( D -- o f— ((®
Marling Address: /'� O. 6 ox / 2 0 2 %
t hereby Certify that I Owl, property adjaceot 10 dw above mkmKxd papetty. The iaatlivWmd applying for this perm
has
cn
des'bed to we
as showtb on 'be anKheddrawing the developmcnt they are proposing. A &smVgpn of dtawin�
With dlmmnSM[ must be pgnJded wah thus sett r
y I have no objections to this pmposai. I have oklectiolts to #his wpusaL
If you have objection to what is W-9 FreFas.d, y.. m.,t notify the Diviaioe of Coastal Management OX"
in writing
within I@ days of zeceipt of this MUM Correspudence stioald be to I27 Cardinal Drive Er
uagtoe, NC 28405-38:& DCM repro can also be eftbxted at (910) 796-721& No regmm is
roasidered the sauce as xo if You have been matified by Certifiied Mail,
E uudefstaud that a pier, doc WAIVER SECTION
k, mooring Pilings, breakwater, boathouse, or lift must be set back a minimum distauce o:
15 from my area of riparian access unless waived by me (If you wish to waive the
�priate blank below.) _ setback, YOU must initial the
I do wish to waive the 15 - set back requirmient.
I do not wish to waive the 15' set back Wit_
,%.PTWJRCr
tic
'rant or Type Name
D� L5oy 7
AaUmg Address
litJc' r%t L
:ity ! Stage /
-elephone -Number " 2-6 `f If o
itipa'us Property.Owner 1uh rmation)
S' �—
`J�
Prmt or Type Name
S 2-5- le-� i✓1fir
Maiffing Address
City / Sty !
Telephone Number

fro
0 IV
Of. tO(V 11�1149'

C'N
p 4-

■ 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:
8` 33
V1
I I' I I I'I IIIIII I I �I II I IIIII I I
9590 9402 2934 7094 9799 46
2. Article Number (Transfer from .�PNr�P rar on
7016 2070 0000 1742 6315
PS Form 3811, July 2015 PSN 7530-02-000-9053
,A. Si / �.!
,Agent
eAA Addressee
B. I rtinfed N e C. Dat of Delivery
Z` R
D. Is delivery address different from item 1? El Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
❑ Registered MailTM
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
El Certified Mail®
Delivery
❑ Certified Mail Restricted Delivery
0 Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
Cl Signature ConfirmatianT"�
❑ Insured Mail
O Signature Confirmation
❑ Insured Mall Restricted Delivery
Restricted Delivery
Domestic Return Receipt