61560D - Deerfield

CAMA / — DREDGE & FILL /f V \ b '
ENERAL PERMIT Previous permit#
-'New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources ' I
Coastal Resources Commission in an ea of envir n to oncern pursuant to I SA NCAC N • ��U
Rules attached.
t Name (t�- Project Location: County F—e,
- 1 Street Address/ State Road/ Lot #(s)
State ZI P �S (% S 4' Gl (� S `� L1 U c,U �'►c u f t
rl c ''rr
Fax # ( ) Subdivision I� �A
zed Agent _ 1 1,1 of k cy�� City ZIP 2
CW - EW --'PTA ❑ ES - PTS YhD�ne�#( )) 231 1 H River Basin ��
OEA HHF IH - CoBA - N/A Adj. Wtr. Body U nat
PWS: FC:
Closest Maj. Wtr. Body
yes / no PNA yes / no Crit.Hab. yes / no Vv `�
Project/ Activity ! V t : i/A � 1.+ r ; J v ', 1 i r �` (� r X1
lock) length (Scale.
pier(s)
length
umber
gad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
)use/ Boatlift
ne Length ' I U
not sure yes
gs: not syre-,, yes
1
mum: (n/a ) yes
yes
Attached: yes
ling permit may be required by: F J.JJ U ( U U n-tb
i e—ini rnnrutinne 4'� -Vrm� /1 ►"-] nil
ter► u.f , ❑ See note on back regarding River Basin

earth feet 800
meters; 200
p-ty ��a; Qa�a+r{ss i s-J�r,ny M lJoC-�L SMa, ,cam
qw �o✓ Our Coo�Jtr a i,���, o tiJ C�tf S Ma/Pf
I/ e rTotio� 13,
Ou cam ea (1 i
/o - Syo - 7�oz
S � `►,,tCt�i o N a�

L�
a`1 e r5 ed O i c:0 keelo M�ssia
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.
Article Addressed to:
/1 0 nn
�JCIGi l (Do e
C414-) J S rece /"I C .
;4 5�ycr1
A. Signature
i, t ❑ Agent
"' �1 -!` `?� ❑ Addressee
B. Received by (Printed Name) Date of Delivery
%1,
D. Is delivery address different from item 1? U W,
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
Article Number 7 012 1010 0001 8392 6140
(Transfer from service label)
Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

5i 1 Z;'ZCI %TUE Uy: R AY
FROM : Jimmy North — CMC
PA:, ti0. r. LluL
FAX NO. : 9102566357 Feb. 11 2013 05:43FM P1
�'IY.tr.+•
north Carolina Departmer,Y of tnvironrlont and Natl.VRI Resources
Division of Coeslat Mariegement
Se%rAta
P 11 McCrory sranon C. Oav,S J�t�r� S. Skvary !!I
ioYemor Dimclor
ZAT FORM
Hate:
N: me Of Property Owner Applying for Permit: Name ut Authorized Agent for this project:
) raf
0 vner's Mailing Address:
P tone Numbert)
Agent's Mailing Address:
Pt.oneNumber(9Jo) ' :5 1--C-
I ertify that I have autt',ofted the agent fisted abr3ve to act on my beriaif, for the purpo$e 0 ,aPIP4ir.g
ft r and obtaining all vAMA Porrnits necessary to ir,stall or vonstmet the following (actift:
F ar my property located at _ i J�,�)' • a ,d r-F
his cert-canon is venal thru (date)
Property Owner Signature Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LF'ec i C le.11 14—OA is
(Name of Property Owner)
property located at 4-,-3 �c /✓© i. f-(G
(Lot, Mod, Road, etc.
on L-�u -,in 64, 45-1n--"-Cl N.C.
� aterbod
(�' y) (Town and/or County)
Applicant's phone #: c'f (D S�3 �— `j� 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT -
(Individual proposing development must fill in description below or attach a site drawing)
tVC) L
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writi
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
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
(Propg2-ty Owner Informati
Signature
Print ol Type Name
(Riparian Property Owner Information)
Signature
kka `kl S L . id ►,J
Print or Type Name
Mailing Address
tip (ApA,*;,uS Ca")€
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: 1,kyl-/ s - h C- bpGktti,c
(Lot or Street #, 9treet or Road, City & Cdunty)�
Agent's Name #: T`-i i! �y�_ ��, i "1
Agent's phone
Mailing Address: —Z, /
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.
y 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.)
I do wish to waive the 15' setback requirement.
✓ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
_L -
Sig �naoro-'
Print or Type N me
M, ailing Address
1,r_li?�NC ��� A).
Citwstate/Zin
(Adjacent Property Owner Information)
Signature
�ICN�\-c L- , NoRRif
Print or Type Name
13 8 Pn,m G-ia sr 1nKit y /VL
Mailing Address
Citv/Statraain

�plicant:
Permit #: 6 Q
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
Name DISTURB TYPE Disturbance total
One includes any
or
temp impacts)
FINALS q. Ft.FAFee
(Anticipated fina
disturbance.nce
Excludes anyludes
restorationipated
andlor tempon
im act amountacts)
Feet FINAL Feet
for. (Anticipated final�itat
disturbance.Choose
Excludes anyanticipated
restoration andlorrestoration
or temp impact
amount)
W Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both Othd ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ OthTEI
Dredge ❑ Fill ❑ Both ❑ OthDredge
ElFill❑ Both ElOthe
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other El -
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

Postal
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Total Postage
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Total Postage 8 Fees $
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