62626D - Ciccone

:AMA / -iDR&GE & FILL �Ay No 626
ENERAL PERMIT Previous permit#
lew —]Modification —Complete Reissue El Partial Reissue Date previous permit issued
�d by the State of North Carolina, Department of Environment and Natural Resources f+' • ��0�
istal Resources Commission in an area of environmental concern pursuant to 15A NCAC t
- Rules attached.
Jame Project Location: County by kj yI r- iA 1 Ut'
Street Address/ State Road/ Lot #(s)
State ZIPAUG �` l_ i V � f r'I S i )i, V
1�> "-Jq5LFax # Subdivi;ion N Pc
(Agent f City ttea ZIP G0•
❑ CW IEW PTA ❑ ES ❑ PTS Phone # ( I v) -513 River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body A-1 W W (Hat
❑ PWS: ❑ FC:
s no) PNA yes / no) Crit.Hab. yes (no Closest Maj. Wtr. Body ► t L GL�
roject/ Activity
2iprap length_
istance offshore
listance offshore
nel
yards
Boatlift
lozing
Of
.ength
not sure yes no
not sure yes no
n: t a yes no
FYesyes no
ached: xOJ.
permit may be required by:
- -- - -. . I
,J
(Scale: I //:
,AJ yJ H t-11,, 1 ❑Can 1,-ar% U_-' / �I See note on back reg4rding River Basin ru
f\ , . - A i. 1 / , I l , , 1 1-1 w I G_ �Yf ♦ / 1 1. it L.!/i t .`.d- 11 1 Y' . . 1 / - 41 J".. .

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
applicant: C '^
a CC©
Date:
1� cs
Permit u �-24'�4
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat 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)
Dredge ❑ Fill ❑ Both ❑ Other
A%
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 El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

W-456/531 J& 1166
KELLY HEWETT BUILDERS INC.
PO BOX 1697
SHALLOTTE, NC 28459
IST BANK
.1. NORTH.. -NA
3104568l: 77L005073110 OIL

Use existing pile
for new roof (3 O
Owner;
Gary Ciccone
197 Greanst�oro Street
Hoiden Beach, MC 2US2
910-988-1954
Existing walk -way
Instali new piles
for new roof (3 )
Install new piles
for new boat lift (4)
Genensl Contractor.
Kelly Hewett Builders, Inc.
PO Box 1697
3hailotte, NC 28459
910-279-5135
Last line of
vegetation from
bulkhead
Existing Bulkhead
not to scale

WDMR
41
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
leverly Eaves Perdue Braxton C. Davis
3ovemor Director
Dee Freerr
Secret
AGENT AUTHORIZATION FORM
Date: / 3
ime of Property Owner Applying for Permit: Me of A4To�rized Age for this project:
t� Wt 1'1G
uner's Mailing Address:
C)0 /317c
Qy e� ✓� /�e %t%�
one Number (` ./y)
Agent's Malting Address:
:rtify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
�ie Y
r my property located at e esl S46,1�-t S v e e/%/c
s certification is valid thru (date) 241
1
Property Owner Signature Date

13 09 55a Gary Ciccone 9103232434 p.1
S %jam,
CERTIFIED MALL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGE M- Et fT
ADJACENT RIPARIAN PROPEitW OWNER STATEMENT
Name of Property Owner
Address of Property: 11-1 C-1-ech s ho ro 3+. 14v(d e rr ?�cacA , MC
(Lot or Street #, Street or Road. City & Counry)
Applicant's phone 9: jQ _q%. IR�5 Mailing Address: -?0 3 Dk 5 5 fC' 8
�C�evi l(e-, NG AU05
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,
wits~ dimensions must be. provided with this lever.
LZ 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 (DCII'I)
in writing within 10 days of receipt of this notice. Correspondence should be wailed to 127 Cardinal Drive Est.
Wilmington, NC 29405-3845. 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, or lift must be set back a minimum distance of
15' front my area of riparian access unless waived by me. (if you wish to waive the setback, you must initial the
appropriate blank below.) n,, In
> I do wish to waive the 15' se: back requirement.! W �� �� "' Y11
I do not wish to waive the 15' set back requirement.
vka
(Pro erty Oynnerlaformat)
Si �re
Print or Type Name
' 3� - s�1�
Marling Address
City 1 State I Zin
(Riparian Property Owner Tnfer1'mation)
t `''ns4*t�
Signature lit
p
Print or Type Name
Mailing Address
City / State 1 Zip

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
�epndyl
1. Article Addressed to:
AcAlks� e►•--
P � R-04, Nc zvw5
A. Signature
(),,( ELA: T ❑ Agent
❑ Addressee
B ceived by (Printed Name of Delivery
,�
D. Is delivery address diff m item yes
If YES, enter delivery sipVp
3. Pice Type
Certified Mail O Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. 7013 0600 0000 3348 4706
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
WiI1�ar►'\ 4-41 ice
J
A. Sign tuj$ I AAA J /
V^ Ad
X 'I'jAVI� 1'4�1I Nnf ❑ ant
dressee
te of Del' ve
B. R, ecQi�ed aJ'?'
D. Is delivery address different from Rem 17 ❑Yes
If YES, enter delivery address below: ❑ No
3. ce Type
Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes