61668D - Hood

CM IbAA / C- DN°
DREDGE & FILL `
GENERAL PERMIT A4 Previous permit#
flew -Modification -]Complete Reissue -.Partial Reissue Date previous permit issued
61
orized 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
,t( Rules attached.
nt Name eey �' Project Location: County/Vecii lg2,"ePye
s Z EL4 t-C L, C✓ee ►tlfl . Street Address/ State Road/ Lot #(s)
/1%1 vti i JZ'*J State Ne ZIP
Aa1x # ( ) "'— Subdivisio'n,�f
ized Agent', F 1 %Ca�+r City fir/� �i'7j/J ZIP
❑ CW eEw 14PTA EES ❑ PTS Phone # ( ) '�� River Basin
d
❑ OEA ❑ HHF E IH ❑ UBA ❑ N/A
❑ PWS: ❑FC: Adj. Wtr. Body lr"�" Ae 1< //-- (nat
yes / no PNA yes, / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
A Project/ Activity
(Scale:
ock)length
length
umber
ad/_Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
)use/ Boatlift
Bulldozing__
ne Length +
not sure yes
cgs: not sure yes
)rium: n/a
� jh�� ;
y no
Attached: yes ( n
ling permit maybe required by: �d _ Th'SC'O�f�l�iS /�� ❑ See note on back regarding River Basin

Y
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) L ' to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) o
at (my property located at) 4�2va !'
This certification is valid thru (date)
—�-) I-13
Property Owner Signature
Date

•
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: Z 4"ZiCAC OaT+!' 1--f=LI'
(Lot or Street #, Street or Road, City & Cot
Agent's Name #: T1 d t Z%� J - Mailing Address:
Agent's phone #: —2,i-.2 - 3 3 `i' - a.s RZ
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.
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 nccoastaimanagement.neticontact 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 waiv4A1 QMVJ0D
wish to waive the setback, you must initial the appropriate blank below.)DCM WILMINGTON, NC
I do wish to waive the 15' setback requirement. MAY 13 2013
1 do not wish to waive the 15' setback requirement.
Owner Information) Property Owner Information)
'N -
as
Print or Type Name
( �g2l�
Mailing Address
n 1s o D
Signature
zeaZ
Print or Type N me
Mailing Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner: �-7;�dcxy?e6i/
Address of Property: l 2 AZ A/L/ i'uA4& 4 ffe
(Lot or Street #, Street or Road, City & County)
Agent's Name #: ' !-�yO`' _ Mailing Address:
Agent's phone #:
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.
IZI 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 nccoastalmanagement.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 V E D
)GM WILMINGTON, NC
I do wish to waive the 15' setback requirement.
MAY 13 2013
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type N me
(Adjacent Property Owner Information)
Signature
Print or Type Name
/?l'7 4:!z .aZ
Mailing Address
Mailing Address

'0.
U
2013 Goople
W l T54.75-N 77'44-4127-W elev Oil
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10
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Eve all 181

)plicant: Y Permit #:
ate: �C
S/3�3
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
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)
Dredge ❑ Fill [X 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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

kBETH E. HOOD 08-97
GTON, NC 28*0e 2820
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