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DREDGE & FILL
"ahENERAL PERMIT Previous permit #
- New Modification Complete Reissue El Partial Reissue Date previous permit issued
)rized 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
it Name U 9 (� "2�sc Rules attached.
Project Location: County &'i I CIS
Street Address/ State Road/ Lot #(s)
State z I P 61A 41�-WJ
Fax # (
ed Agent
CW EW PTA ES El PTS
OEA HHF I H UBA El N/A
PWS:- FC:
yes / no PNA yes / no Crit.Hab. yes / �o
Subdivision N
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City— -&Ivs ZIP J61
Phone# z JAryu River Basin Lu tv
Adj. Wtr. Body k(O. � sk, �/- 1 V4"- fnat
Closest Maj. Wtr. Body A\ t'�3V3
Project/ Activity lkf A J
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(Scale:
k) lenzth
pier(s)-__
length _
camber
-
.acl/'Riprap length
Lvg distance offshore C
nax distance offshore -A
channel
:ubic yards
amp _
ruse/ Boatlift
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CERTIFIED MAIL — RETULN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent toll3OA10-0A C;0-(t 5 A - IS
(Name of Property Owner)
property located at '5t `f
Lot Bloc , Road, etc.
/ [ t , in � !A1 QS 4�na
Mr
y i C l N.C.
on �lc /ct U 4S /t /Zi 1/ e r�
(Waterbody) ( onounty)
Applicant's phone #: q1 Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal. A _ _ -^' J A (t Lcxj I
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
vidual nrann.cing development mus . rill* description below or attach a site drawing)
05�d bw
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Cepl To
kto da, a t- aW47-
A-
Co% r
off ` ReS�t a ra:
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in Wri
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, N1
DCM representatives can also be contacted at [phone].
No response is considered the same as no obiection if you have been notified by Certified Mail
(Property Owner Information)
Signature /)
Print a Name
(4Upafiea Property Owner Inform tion)
Signature
C �— t1 �r , ✓l � _
Print or Type Name
q3 /VaJ'tce Site
/ F 1 ©fit/L—rCr�C
Mailing Address Mailing Address

GAG/r ✓Gry
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Qi(/ �-e
(Name of Proper2;ty Owner)
property located at 42-�-2 CU_t �
(Lot, Block, nRoad, etc.)
'✓c.r ,in "_#'Ls wien—k- N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development) - ---
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Kil
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Ca�r�iSs
---------------------------- ------------------------------------------- -- !!.L4:1----- --------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
iXf7 O S «
Mailing Address Signature
— e /

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iplicant
ite:
y /Sc
/1 -3
JV�.�s��� Nam.
Permit #:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
�itat Name DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternimpacts)
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)
Dredge ❑ Fill�1 Both ❑ Other ❑
110
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 ❑

HN'S SEAFOOD HOUSE, INC
NG ACCOUNT
;T SW PH. 910-579-6011
, NC 28467
i rst Federal
DATE / - Jv ' 1-3
6308
67-7194/2532
/ L/G
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