61685D - Brown

❑'CAMA / ❑ DREDGE & FILL lr ? 61
GENERAL PERMIT Previous permit#
Y—New ❑ Modification Complete Reissue ❑ 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 I SA NCAC e�'
Rules` attached.
nt Name A - ;A "/ 4FKPW Project Location: County AlGt-t'
f1 � / i�l�i'�H-r Ow ) 'ol Street Address/ State Road/ Lot #(s)
Y' r t �11h State_ ZIP
# ('l0) %o '.SZ Fax # ( ) Subdivision
ized Agent - City / A ' ZIP
dE CW VtW L-OTA
❑ OEA ❑ HHF IH
❑ PWS:
�j f�
C e. no PNA /ies /
A Project/ Activity
ock) length
m(s)
pier(s)
length
umber
:ad/ Riprap length
vg distance offshore
iax distance offshore
:hannel
ubic yards
imp L
i / Boatlift
Bulldozing
E5 PTs Phone # River Basin �G�
UBA ❑ N/A Adj. Wtr. Body llti�/ �'`
at_
Crit.Hab. yes / no
Closest Maj. Wtr. Bodyh�
�' r//,
ne Length
not sure yes
gs: not sure yes ,no"
)rium: n/a yes ghoiyes �-
Attached: / '; no --
ling permit may be required by:�
(Scale: /
^FIL
hG�H// ra s ;e�c �,,t�,pf ,❑ See note on back regarding River Basin

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 8LtJ 3�,�(► �) OU„s � J
v
Address of Property: /e ,2�q M V A ! .t f C. A. 6 y ( At) 1N - HAA,
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address: Si9Mi
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.
l� I have no objections to this proposal. I-'- 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.) P F
LJ r
I do wish to waive the 15' setback requirement.
- J
�...
� . , • I do not wish to waive the 15' setback requirement. k C,
(PropertyrOner Information)
Signature
& N i A141 t ti_ !�J . �S1--V JIA_j
Print or Type Name
(Adjacent Property Owner Information)
Si nature
yAMQ '�? 1 K iJ
Print or Type Name nn
16
Mailing Address
Mailing Address
r�

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: A)19m I fU PP nu�) A)
Address of Property: (. � M V 1'Z 1 (; k6 V ( AD. AQ , RAA J,
(Lot or Street #, Street or Road, City & County)
Agent's Name
Agent's phone #: ' L—26,�.
Mailing Address: _15',4MIC
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.) , FLAW IN
I do wish to waive the 15' setback requirement. a
I do not wish to waive the 15' setback requirement.
(Property O ner Information)
Signature
-N JAff(N
Print or Type Name
(Adjacent Property Owner Information)
Signature
,-Zl(k cl C&-
Print or Type Name
vLIi
Mailing Address Mailing Addres

B D BROWN 6718
6207 MYRTLE GROVE RD
WILMINGTON, NC 28409 66-21/530 10517
1010183406439
/� to
Pay to the % � / /
Order of l `// / $
Dollars
Wells Fargo Bank N.A.
North Carolina
®-wellsfargo.comIQ
_.
NP
1:053000 2 191: 10 10 11334064391I.067 18

pplicant: /
Permit #:
ate: �ZP, 2/
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat 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/orternp
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)
Dredge ❑ Fill ❑ Both ❑ Other Or
/ yL/
11
v/
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 ❑