63153D - Harris

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wiCAMA / DREDGE &FILL �(' ,�} 3•' �>'
3.ENERAL PERMIT Previous permit# QVI
ew ❑Modification CIComplete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources IG
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7
r 77'el
hed.
itTA�'' Name { Project Location: County
Street Address/ State
/Rgad/ Lot #(s)
/✓l !I'lrl YN StateAk ZIP 20P 3 Gji.
O Fax # O '"� Subdivision
red Agent City f�f//ZA'i>ii�y,�i, ZIP_
❑ CW FfW E4TA ❑ ES ❑ P Phone # C4 ,
� (�) .SyG''.��f�i-River Basin
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body i/air e nat
❑i PWS: ❑ FC:
yes /,•'noPNA es no Crit.Hab. yes / no Closest Maj. Wtr. Body
f Project/ Activity
ick) length
n(s)
!ngth
tuber
d/ Riprap length
g distance offshore
ix distance offshore
hannel
bic yards
np
ise/ Boatlift
ulldozi
e Length
not sure yes Crg7
s: not sure yes dR
ium: n/a yes Cp
69- no
kttached: y no
rrl S . �I
ng permit may a required by:
i
(Scale: / �!
❑ See note on back regarding River Basin r

F AND S MARINE CONTRACTORS INC
PO BOX 868
WRIGHTSVILLE BEACH, NC 28480-0868
r.
PAY S�'
TO TEHj
ORDOF
3604
15-3/540
DATE J 893
, $ ze9w
DOLLARS
(D.,PNCBANK
;-'fNc B 4 i
c
N.A. 0
ARk - i f'%M ; Xr

tt6
Applicant—T IM
Date:
� 3 is3 -�
Permit #:
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
labitat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount
W Dredge ❑ Fill ❑ Both ❑ Other
31
3 ( v
ill ❑ Both ❑ Other ❑
ill ❑ Both ❑ Other ❑
ll ❑ Both ❑ Other ❑
TDredge
ll ❑ Both ❑ Other ❑
ll ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill [I Both [I Other El
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

A K.;.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: �2v / -L'
lame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
j om ;6
Wrier's Mail' g Address:
l 10/ jCi almo /47
'hone Number(9i�)
Agent's Maiy1&A 74W
owi 46.
�910�.25�3fJtS2
Phone Number ( )
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
or my property located at [ 10 51, Wow k , AIJAiiiom P L ; ffwj
his certification is valid thru (date) /.L/✓�`/I �/
Property Owner Signature Date
RECEIVED

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
/ (Lot or Street #, Street or Road, 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
n�\ they are proposing. A description or drawing, with dimensions, must be nrQyided with this utter.
/�_ 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 you have been noted 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 Information)
Signature
4JW, w4a,0115
Print or Type Name
I 101 5/ ,f�wy><� hip
Mailing Address f�
N
C/ty/Stat i
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip"

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
�
Name of Property Owner: loiii /41`'t,
Address of Property:
I10 s�'TIL�,xut�,il,, l.,t,.�«,n,, �Jc 29YU
(Lot or Street #, Street or Road, City/ & County)
Agent's Name #: j& i ," `�.S��MK�€� 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 jhe development
they are proposing. A description or drawing dimensions must be provided with this letter.
4.5 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, 2W5.3W. DCM representatives can also be contacted at (910) 796-721& No response is
considered the same as no objection /f you have been nod ied 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 Information) �, (Adjacent Property Owner Information)
6 rn T l c, .,,,,.-
Signature Signature
c--
/ r' nay -3
Print or Type Name Print or Type Name
Mailing Address Mailing Address
tx ? -►gal f� �-,-, &► C--,
CitylStat&0CVIStatelZip

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