64717D - Welfare

CAMA / El� 4
DREDGE & FILL `� '
'iENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
zed 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 ul f`yU
❑ Rules attached.
Name Project Location: County W m %�-
7- Street Address/ State Road/ Lot #(s)
Stated ZIP G 1 i w E ST %� /
Jt? )S�'Fax # () Subdivision
.-d Agent C.f' fiyeG'/'�' City SU/t {C ZIP
ElCW t�,EW �C PTA ❑ ES ❑ PTS Phone # ( River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body <"tNl 1, 00"F -410' ✓ (nat 0
❑ PWS: ❑FC:
yes /' io PNA yes no Crit.Hab. yes / no
Closest Maj. Wtr. Body "�o�
Project/ Activity
r
:k)length x
(s)
ier(s)
n h
r�
i/ Rlp4t length
distance offshore
a distance o
cannel
sic yardnp J
e/ Boatli h
ie Length
not sure
;s: not sure
rium: n/a
Attached: yes no
ing permit may be required by:
❑ See note on back regarding River Basin

III Wzu 10 m"ydll ul uR.a IrIC111C
uynu Vnvca
nay u
.p ivv.vv ,
7/17/2015
7/20/15
Stanley or Sharon Stubbs
same
B of A
4859
$200.00
GP for 1304 Caroli
7/17/2015
7/20/15
Richard or Sharon Love
same
Wells Fargo Bank
1434
$200.00
GP 64712D
7/17/2015
7/20/15
Antinori Construction, Inc.
_
Chris Mohr
B of A
3780
$200.00
GP 64715D
7/17/2015
7/20/15
Holden Dock & Bulkheads
Anna Odam & Rufus Yates
CresCom Bank
2181
$200.00
GP 64697D
7/17/2015
7/20/15
Atlantic Coast Industrial LLC
David Brinklev
BB &T
11791
$200.00
GP 1400 Point Hai
F 7/20/20151 IMoney order from Brandon Grimes IPatricia Welfare (Wells Fargo Bank 117-213876532 I $200.001GP 64717D

MC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �j'�` ((�I(� YVCG(�� Permit #:��-
Date:
%
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temlp impacts
FINAL Sq. Ft.
(Anticipated final
disturbance.
Exdudes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and lor
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
l ,
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 ❑ Fill ❑ Both ❑ Other ❑
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIP iAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: — IM _ `i 7
(Lot r Street #, Street or Road, City & County)
Agent's Name #: %Liw Mailing Address: iza Al
Agent's phone#: /S, fla,a�1 .—E:s� . it' L. �2S 5lV3
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.
I have no objections to this proposal I have objections to ttus proposal.
If you have objections to whet is being proposed, you must notify the Division of Coastal Management (DCM)
In writing within 10 days of receipt of this notice. Contact information for DCM offices is available at
http:r;'www.nc:ca. evwetivcrwstafh-listing or by calling 1-888-4RCOAST. No response is
considervid the same as no objection N you have been notified by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings. boat ramp, breakwater boathouse, or lift 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 )
� � 1 �- f)-1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Property Owner'Intormation)
Si ture
pmT,f r!, IN LtJt:7--1
Print or Type Name
5-02 t', OH, -- 'r
Mling Address
fs
city/state/zip,/
2/53y- _7� I p�tt� ; c,� ..�e�{�f4
Telephone Number Email Address
Date: y -/I, -- zr» -i-
(Ripsnnppeyty wnen Information)
-�—� uNAE 1�oCYr3J--�
Print or type Both Nar*s
06 z�'I -3 n x V l S
a g Adtires�` .IV
rVStaf ip
Cl-D7S;-; 919-?�z1-706/

I hereby certify that I own property adjacent to _ I G f/ t , °-' W (U61 a" � s
1 (Na of Pro61 ner)
property located at t—
�j (Address, Lot, B ocl , Roa , tc.)
on /`? G /" l 1 in l3 ' � '/ , N.C.
( aterbody) (City/Town and/or ounty)
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)
W6IVER 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) (Adjacent Property Owne I formation)
Signature sign?re
(�e
('.5 bg
Pnnt or Type Name print or 7yype Name
Mailing Address Mailing Address
cit)uStatemp city/stateap
Telephone Number Telephone Number

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