63201D - Painter

CAMA / ❑DREDGE &FILL ��`
ENERAL PERMIT � Previous permit # --
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued r--�
4
zed by the State of North Carolina, Department of Environment and Natural Resources 1 ' 1
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rul attached.
Name Y7� Project Location: County
ko' C2 �13treet Address/ State Road/ Lot #(s) 1 I
'1 StateM�.�._._ ZIP a�1,f�_
—
sd Agent
❑ CW
�j W
[ PTA
C OEA
❑ HHF
❑ IH
❑ PWS:
❑ FC: _
yes no
PNA
yes / no
Project/ Activity
:k) length
ier(s)z?—� �
ngth
tuber
d/ Riprap length
; distance offshore
v distance offshore
cannel
--
bic yards
lulldozing
,e Length
not sure yes nod
i
gs: not sur yes no
rium: 'n/ no
ye no
Attached: yes 1 no
ling permit ma be Fequired by:
❑ ES ❑ PTS
❑ USA ❑ N/A
Subdivision
�. City VAO W ZIP
i q
V 1'' 014llone # ( ) River Basin
Adj. Wtr. Body �- < l �Va l nat
Crit.Hab. yes / no Closest Mai. Mr. Body
❑ See note on back regarding River Basin
L�

PAY
TO THE
ORDER OF
SOUTHEASTERN COA S�TRALACONSTRUCTION CO.
WILMINGTON, NC 28403
[phone] ;
Fit]
®AIA
FIRST FEDERAL
8985
67-7194/2532
DATE J -72` - /
$
DOLLARS ❑ """"'
B.ck.

'C Division of Coastal Mgt. Habitat Impact Computer Sheet
)plicant:/`/�,11) t/ Permit #:
31e:
BIZ-, �iy
;scribe 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
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 fina
disturbance.
Excludes any
restoration andh
temp impact
amount)
Af\1
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 ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
-ly Eaves Perdue James H. Gregson Dee Freeman
rnor Director Secretary
AGENT AUTHORIZATION FORM
Date: 14
of Property Owner /��Applying for Permit: Name of Authorized Agent for this project:
;r's Mailing Address:
A P&4 -4
/V
ie Number (` tg)
Agent's Mailing Address:
G1,i i � ✓� c n 0 � . L.
Phone Number 11 e) S� —� 31
tify that I 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): �n
Lc
property located) at 3 126,^4
Property Owner Signature Date

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIP,AJRIAN PROPERTY OWNER STATE MT
EN
Name of Property Owner: (, � �'�L c f 7itz —
Address of Property: 31 I e 6 e / �clr.
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: W,7 %Z - 3/05- Mailing Address: % 5 e K F rk-s k sctf le -5:U
&L z7&a
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 of drawing,
with dimensions, must be provided with this letter.
V 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) 795-72I5. 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, 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.)
I do wish to waive the 15' set back requirement.
I do 4bt wish to waive the 15' set back requirement.
Signature
YL
�intType Name
6,G i
M iling Address
(Riparian PK4 erty Owner for ation)
Signatures
Print or Type Name
Mailing Address
Q.-.- ,

CERTIFIED MAIL -- RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: _?2 1 eatNe4e 41 /Vyw, &a
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: (/`��p �2 - WO-5 Mailing Address: �6 D 1 Sc')( I o Ith R Sic! ^,k 3-2
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 of drawing,
with dimensions, must be provided with this letter.
Y 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 (9I0) 796-1215. No response is
considered the same as no ob'edion if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
�— I do wish to waive the 1 S' set back requirement.
I doAbt wish to waive the IS' set back requirement.
Signature
4tint or T e Name
e_
Z160/ Ski 2les A �UI r 5 2
M iling Address
formation)
Print or Type Name '
Mailing'Address
i
ti

P;C
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