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Se�AMA / ❑ DREDGE & FILL Q� Q �`
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3.ENERAL PERMIT
Previous permit#
?&ew Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
rized 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
ules ttached.
it Name `G`
Project Location: County
h+
.222-S
Street Address/ State Road/ Lot #(s)
State ZIP
Subdivision ---
:ed
City '41111 �h ZIP
PI CW [B1�W 4r ❑ ES ❑ PTS
Phone # River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body nat
❑ PWS: ❑ FC:
yes PNA &/e / no Crit.Hab. yes / no
Closest Maj. Wtr. Body 7 y"
f Project/ Ac
hL w el ree S t VAI,
�c) length V x %1
;k
ier(s)
ngth
tuber
d/ Riprap length
distance offshore_
x distance offshore
cannel
>ic yards
ip
se/ Boatlift
1
Adozing
ik
Length G
not sure yes
not sure yes
cum: n/a yes
yes
attached: yes
ig permit may be re
(Scale: /
JAMES W JONES JR
DONNA M JONES
4522 DEAN DR .
WILMINGTON, NC 28405-2409
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QPNCBANK
PNC Bank, N.A. 040
For_
6 3czD
I:0540000301: S321912?P7,?Ilo 1 L. 1
1417
15-3/540
892
�p�pl�DJ
safe:
Permit #: V 32 dD
escribe below the HABITAT disturbances for'the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
ibitat Name DISTURB TYPE
One
TOTAL Sq. Ft. FINAL Sq. Ft.
(Applied for. (Anticipated final
Disturbance total disturbance.
includes any Excludes any
restoration
restoration or and/or temp
p iimpaacts) impact amount
TOTAL FeetF
(Applied for.ted
Disturbancece.Choose
total includes
any anticipatedn
restoration oractt
temp impacts)
eet
final
anyanticipated
and/or
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 ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0
Fw�
A *`A
RCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skva
Governor Director Secreta
AGENT AUTHORIZATION FORM
Date: fj
Name of Property O"er Applying for Permit:
Owners Mailing Address:
Phone Number(
Name of Auth *rZ d A gen t for this project:
"T
4r
Agent's Mailing Add eS
X/
4"
o� /0
Phone Number
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at
This certification is valid thru (date)
Property 0%iviter Signature
461J-Z
Date
R E C, r— I ;D
DGM WILMINGTON, NC
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FLOI} I�Q
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6 x 140
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: U 1 �- 6 S
Address of Property:
or Street #, Street or Road, City & County)
Agent's Name #: J/C JQA)eJ
Agent's phone #: - f
Mailing Address: 41 Zz && Ae
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 re proposing. A description or drawing with dimensions must be provided with this letter.
f
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 Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 796-7215. 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.) RECEIVED
I do wish to waive the 15' setback requirement. DCM WILMINGTON '
APR 0 9 2014
I do not wish to waive the 15' setback requirement.
(Prof-erty Own r Information)
ignature
JC/w
Print or Type Name
/.o6�,- Awe 9/&Vv///,e
Mailing Address
s ` . i
..-7
(Adjacgit Property Ownerormation)
Print or Tye Na e
:7 703
Mailing Address
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ 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:
-7703 cone
rya 3
A. Wign7areCl Agent
X ❑ Addressee
N?me) C. Date f Deli ery
D. Is delivery address different from item 1? LIJ Yes
IfYFB� a� y ry,,� Idress bent: N(C7 No
APR 0 9 2014
3. Service Type
40 Certified Mail ❑ Priority Mail Express"
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ Collect on Delivery
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7013 1090 0000 6086 9459
(transfer from service label)
PS Form 3811, July 2013 Domestic Return Receipt
Postal Service,,I
QTIFIFD MAILrr, RECEIF
' (Domestic Mail Only; No Insurance coverage rrovtaea/
For delivery information visit our website at www.usps.com® 01
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Postage $
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Postmark
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Return Receipt Fee
(Endorsement Required)
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Restricted Delivery Fee
(Endorsement Required)
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Total Postage & Fees
$
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See Reverse for Instructionrl
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PS Form :02006
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U.S. Postal ServiceTr.,
CERTIFIED MAIL,,, RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided
For delivery information visit our website at www.usps.com -