62551D - Adler

AMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
-]New El Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �f� LU v
ules attached.
nt Name L. AOLLA ( I ki I SriX C I CA PAi Project Location: County 49- t( nJS1,,J ► C4<-
a 1031 hyy'tt�„�' �J;;?C1pS ;)Vi , Street Address/ State Road/ Lot #(s)
-L ' 1 CTT C StateNA V1 ZIP 2 1 04 Z ZS c;�e4- I-. V Ar r t -( VJl L -
# () - ,7 c b j Fax # ( ) Subdivision
-ized Agent
d ❑ CW
❑ OEA
DEW `PTA �J.ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: FC:
yes / ,po PNA yes / no Crit.Hab. yes / no
Cityi1 --%L 1ZIPLf
Phone # ( ) River Basin
Adj. Wtr. Body_, LA i ��/ Cafr
Closest Maj. Wtr. Body f; i tA -, 142
Df Project/ Activity R- ftl'Vt,�2 An
(Scale:
lock) length<4`rC `y 4
pier(s)
length
lumber
md/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards
amp
)use/ Boatlift
Bulldozing
ine Length�'1
0
not sure yes
,nq
kgs: not sure yes
�r0
�rium: n/a yes
,n4
yes envy
-Attached: yes (�n�o)
ling permit may be required by: Q IV4 1 S"4-- JO
❑ See note on back regarding River Basin

e
Applicant: A.0 C W i S C( l Permit #:
Date: t/y
2(31113
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
'ound in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
habitat Name DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
/�
Y " 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 ❑

►N oens 109
65-320/550 7378
3448876031
3► zo �3
or��
s a�oo
Dollars
F.
�o
44887603I'll 00 L09
BLUE SHEFFIELD"'

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ,) A/A ter S h ✓I �b h z 1- a ✓1
Address of Property: hT � Gun-,
(Lot or Street #, Street or Road, City & County) G Z? c/&Jc
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 a7psgon. 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 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) 4Ad"acent Property Owner Information)
41-1'
All,
Sign ture
rPrin4�tC�NT pe Name Print or Type Name L--7 I
. - -g I,(� u i 1. n I 1cCJ P-, 64E&I
Mnilinrr AfiHnacc f AA.,;r— n.J.J—

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:_ct' ,� Ad L. r In
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County) N ,G 2-T 44-5
Mailing Address:
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 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.)
DECEIVED
`4�L� I do wish to waive the 15' setback requirement. DCM WILMINGTON, NC
I do not wish to waive the 15' setback requirement. JUL 1 0 2013
(Property Owner Informal n)
Signat e
�3r �- R�
Print or Type Name
(Adjacent Property Owner Information)
1441�Signature
Su Safi ri 5/ZT-V-, S"Li�
Print or Type Name
IQ31a Wa Ve✓ l `/ wo0A-3 Dft ve � � Ch �b� n �✓�
AAnili— n,a,r-- ., -

:er-Coastal Waterway approximately 420 feet wide
12 feet
14 feet Water depth at low tide = 2 feet
feet
29
Steps > I I I I I (No Marsh Grass)
H
3erty o fl4 feet Prope

ram+
CD
r-t
N
O
O
m
lI