63196D - Gerity

1CAMA / ❑ DREDGE & FILL ` ��`
63
3hENERAL 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 Commission in an area of environmental concern pursuant
to 15A NCAC
t Namek.VIA 0 �
Rules, attached.
Project Location: CountyANLA ��
11
Street Address/ State Road/ Lot #(s)
YrlA • >~ S ZIP2*12-
() --, Fax # ( )
Subdivision
Pr
ed Agent u1p 1VAak! 1 A g ►1 eu -114k
City ���i�Q ZIP
CW `1,EW PTA ❑ ES ❑ PTS
c^�
Phone # River Basin
1Q
C OEA r� HHF ❑ IH ❑ UBA ❑ N/A
/
Adj. Wtr. Body l Y
at r
G PWS: ❑FC:
yes /(io) P N A yes ) no Crit.Hab. yes /ono./
Closest Maj. Wtr. Bo cjy A W W
Project/ Activity
:k)length
(s) 8 �`
er(s)
igth
nber
i/ Riprap len h
distance offs ore
x distance o hore
annel
iic yards
ip
>e/ Boatlift
illdozing
i I A IV umP Vi
Y4
Length
not sure yes �no a
not sure yes no
um: (a / �yess no
stached: yes no
ig permit may be required iy:
(acaie: I ;
❑ See note on back regarding River Basin rr
r f f I . .

stir

LARRAINE W GERITY
KEVIN GERITY
PH. 919-280-1855
1344 HILL VALLEY WALK
WILMINGTON, NC 28412
j -'Wd Clark,
oo
GC,
5
12 11:000 5 2 17 IS 78 6 4 1'030 2 J
1025
66-112/531

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
PPlicant: [�(;V I Y � �r `, l-(��/L� 1""Cf I t I I L ii-. � � ((� /
ate: � U
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
,und in your Habitat code sheet.
abitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fin
disturbance.
Excludes any
restoration anc
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
`
1 LA
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 ❑

A.-N A���.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
t McCrory Braxton C. Davis John E. Skvada, III
iovemor Director Secretary
AGENT AUTHORIZATION FORM
Date:
ie of Property Owner Applying for Permit:
C, E r2 1
ier's Mailing Address:
4g t41 1 VA--( I e 44tL
t t Fit o j. Ec D N C 2sq (Z
ne Number c(� 3 C)L -,5L45--:?-
Name of Authorized Agent for this project:
Agent's Mailing Address:
Phone Number
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
nd obtaining all CAMA Permits necessary to install or construct the following (activity):
'e- Ac-c- VV\eP-) ��X_k-
my property located at
3 c+ L� �A, � t Vklle�
certification is valid thru (date)
Prop y Owner Signature
Date
L6<113 11A&
zS y I Z

NT
R STATEMENT
I hereby certify that I own property adjacent to
property located at
I W� lCl �ti (Addres'n
on t
(Waterbody)
;Name
. I J:
I
W -C- A& Hevwer, N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatio
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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bacl
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wai
the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
V I do not wish to waive the 15' setback requirement.
(Property Owner Inform n) (Adjacent Property Owner Information)
?Z0/1c
ure Signature
t,
Print or T pe Nam Print or Type Name
aup 4"W Nam Y L"J4 Ik

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
-%1
Name of Property Owner:
SS
Address of Property: 1-3 q 0 P" 0( h C
(Lot or Street #, Street or ad, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
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 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 [phone]. No response is
considered the same as no objection, if have been by Certified Mail-,
f you ua�c uccn
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. / V l
I do not wish to waive the 15' setback requirement.
oMlnf ormation))
amxiviu-
Siignatu
Q-R)krxsS
Print or Type Name
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
Mailinq Address

,I
.5
I .
1��=mod 0 N'W pGI SSca C-L