60766D - Gordon

8 0 ✓ No. 607
C� AMA / 'DREDGE & FILL
MNERAL PERMIT Previous permit #
New -Modification -Complete Reissue '--!Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources . `i
�astal Resources Commission in fan area of environmental concern pursuant to I SA NCAC ules attached.
Name'1Y►'i%t b�++ Project Location: County —RNA
�j �VflSh/1 GEC.
��32 �ta �� A V e s) v e, Street Address/ State Road/ Loth#'(s�)�"
Stag ZIP l/� �1bVlrZ� ,�Tr -e&
O {{ Fax # ( ) „
W:L
M Agent I t`t r
❑ CW EW XPTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FFQ
yes 1 no �,1 PNA ye; no Crit.Hab. yes
Project/ Activity tA'4s't L4 V W
ck) length
ngth
tuber
d/ istanc length
� distance offshore
u<distance offshore 1.5
nannel
bic yards
np
ise/ Boatlift
iyl.ldozing
i�
? c�
d
ie Length 6)L)
not sure yes { no
gs: not sure yes
rium: n/a yes no
yes no
Attached: yes no
ling permit may be require
Subdivision Iv
ity ZIP
Pkf ne # u 2-3Z- River Basin LA) WV_
Adj. Wtr. Body cmand
Closest Maj. Wtr. Body A 1 ow
(Scale: y

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cn� p�
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yve VJ 0/-6

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
CA�
Mailing Address:
-+_
Ae-
I certify that I have authorized (agent) /411i<) ito act on my
behalf, for the purpose of applying for and ob1t
J/-
install or construct (activity) � 2
at (my property located at) QJ L�.,h
This certification is valid thru (date)
all CAMA Permits necessary to
1
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or 'fStreet #, Str or Road, city & c unty)
Agent's Name #:
Mailing Address:
Agent's phone #: 7/U
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.
V 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. Contact information for DCM offices is
available at www nccoastalmanapement.net(contact dcm.htm or by calling 1-888-4RCOAST. 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.)
1� I do wish to waive the 15' setback requirement.
�'f \ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or y ame
(Adjacent Property Owner Information)
Q
Signature
4" h0
Print or Type Name
163 � �h� I� � ke,
AL-illn— AAAec

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: chff`es Cmdlely\�
If
Address of Property: zwlob`
(Lot or Street #,
OGtivl 4.,SI e-
or Road, City & County
Agent's Name #: Radq �'� 1 r o3�c Mailing Address: Q, )4tl oZU j
Agent's phone #: L7j -_ 3Q -.? 6 3 u ocJ- tblevd ,-2
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.
hve 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. Contact information for DCM offices is
available at www nccoastalmanapement net/contact dcm.htm or by calling 1-888-4RCOAST. 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)
�Z
Signatur i
Print or Type Name
jS�aZ A!cr.�/�—
y
(A ' nt ope ner Inf ation)
J- � �/ "rz
Signature
�Di1GL1 � Elnl/rlf�' .�►r'
Print or Type Name
IDO
Ail-W— drMrnee

1 <
Division of Coastal Mgt. Habitat Impact Computer Sheet
Acant: Cf � o v�s 6 cr( o-.,
11-b / 1.3
Permit#: '( uio
scribe 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
Dredge ❑ Fill ❑ Both ❑ Other ❑
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)
2-�
7:�q-
Dredge ❑ Fill ❑ Both ❑ Other ❑
--4-s
Dredge ❑ Fill ❑ Both ❑ Other ❑
�
Dredge ❑ Fill ❑ Both ❑ Other ❑
�D
Sv
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 ❑

■ 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:
u
A. Signature n
X J � % �"i S ❑ Agent
�❑ Addressee
B. Received by (Pn ted N me) C. Date of Delivery
12- - //7-
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Serv} e Type
Qj.rtified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for MerchandisA
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number -
(Transfer from service fabeo 7 011 0110 0000 8670 1663
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 tp:
A. Sign e
X ❑ Agent
❑ Addressee
B R i d taddrefferent
Name) C. Date of Delivery
u��1�9
D. Is delivery from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Seryibe Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number --
(Transfer from service label) 7 011 0110 0000 8670 16 7 0
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540