61515D - Dellinger

-rAMA / E-' DREDGE & FILL
3t N E RAL PERMIT b Previous permit #
JNew El 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
[-] Rules attached.
ntName (i Project Location: County
c 22 i CL Street Address/ State Road/ Lot #(s)
State ZIP 2 (PQ '1
4� O Fax # () Subdivision
v Li
zed Agent i � b-,- � ' I Q � UL City .t t1 a F �( �L� ZIP_
CW SEW ❑PTA ❑ ES ❑ PTS Phone # (� I I_ ) �'. ��(.: 3.`:. River Basin f_LJ►vj
i ❑ HHF _ IH __ UBA ❑ N/A OEA p (nat� ; ���
Adj. Wt . q ❑ PWS: -FC: /i LUUJ
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body /
)f Project/ Activity
ock)length,
m(s) Y ZU'
pier(s)
ength
umber
ad/ Riprap length_
ig distance offshore
iax distance offshore
:hannel
ibic yards
imp
'use/ Boatlift
Bulldozing
X
ne Length
If
not sure
yes
no .
gs: not sure
yes
no .
)rium: n/a
yes
no ,
yes .Ao
Attached:
yes '
no
ling permit may be requires
(Scale:
i! i n . . .I . i I , L - 1,., 1

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date /— 3/-13
Name of Property Owner Applying for Permit:
Oi4!/4 L Z�Pl�/�V4
Mailing Address:
,�33F
c,Q74A1,,V14 , A4,L`
I�
I certify that I have authorized (agent) �J e S51 t 'IYK M O)J5 to act on my
behalf, for the purpose of applying for and obtaining call CAMAPermiitts necessary to
install or construct (activity) Per 4- -RO4*1' cloc!C 1ic�J/{'4ylt d ,
at (my property located at) 12 a 3 M► 4 SAorP f) r ry c
S �(� SCC AC hf /V C
This certification is valid thru (date) 3 — 3 0- L 3
Owner SignatureL--� U Date

C4,(Qz-- -�
L S-rAa �-lstilif-->
wR* I to c:;)oc4
I)t4vild 1�011'pyer
I� 0 3 Nor- A S hvre Dom, �
j(,-Ak---)se-j geA-c-l�'11'4C

Hello, my name is Jesse Simmons and I
am an agent representing Mr. David
Dellinger. As required by CAMA we are
required to inform you that he is in the
process of obtaining a permit to construct a
6'x22' pier leading from his bulkhead to a
10'x20' floating dock positioned 42' from the
bulkhead out to an established pier head
setback. Mr. Dellinger will not be asking to
encroach on the 15' setback at this time but
would reserve that right for a later date. If
you have no objections or concerns you
need to do nothing and you may keep all
this info for your files. If you do have
concerns simply follow the instructions on
the form.
Best Regards,

Ip licant: j�,,II .
P �aV(al 11�1�l Permit#: W5ISD
)ate:
lescribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet.
abitat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
f
C(/V
Dredge ❑ Fill ❑ Both ❑ Other
90
l�
Dredge ❑ Fill ❑ Both ❑ Other
I
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 ❑

mplete items 1, 2, and 3. Also complete A. Sign
n 4 if Restricted Delivery is desired. ❑ Agent
nX t your name and address on the reverse ❑ Addressee
that we can return the card to you. B. Rece' by (Pri t Name)",' C. Date of Delivery
ach this card to the back of the mailpiece, .f1
Dn the front if space permits.
D. Is delivery dre(* Oifferent m iterr4 1 ❑ Yes
cle Addressed to: If�ES, er deli address below: i ❑ No
ANC 1401 JIL93 os l
5 7 y m eNs IN 13ur G4'Oe
1. / /0 /� ^ / f 3. Service Type
r / -f / / 1( (.. Certified Mail ._ --P- impress Mail
V L16 ❑ Registered ❑ Return Receipt for Merchandise
O ❑ Insured Mail ❑ C.O.D.
C'
4. Restricted Delivery? (Extra Fee) ❑ Yes
;le Number -7
lsfer from service label) / y1tJ 0DO 7D� ! SJ O
�m 3811, February 2004 Domestic Return Receipt
items 1, 2, and 3. Also complete
3estricted Delivery is desired.
r name and address on the reverse
e can return the card to you.
is card to the back of the mailpiece,
front if space permits.
tressed to:
le to
S x,l N
(ANe
Co 0
102595-02-M-1540
A. Sign a r /
X ❑Agent
^ Addressee
B�Rec iv by ( Tinted Name) C. Date of Delivery
D. Is delivery address differeri'tArn item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
eservice label) 760 9 y/o 000 / 9 7L 5' y 3
om
11, February 2004 Domestic Return Receipt
102595-02-M-1540
O
UI
1z
a
a
O o
U
~
�/
i
H �
Qmu�
__
U
rn
mmC-\