61605D - Heath

CAMA / DREDGE & FILL /� /I 6 M 61
GENERAL PERMIT f Previous permit #
New 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
El Rules attached.
nt Name I �: �'; Project Location: County
s
State,_ _ Z I P
#� )_iG !I`ikk� Fax#(( )—
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izedAgent
d CW EW PTA ES ❑ PTS
OEA HHF IH ❑ UBA N/A
PWS FC:
yes ./ no PNA yes /' no Crit.Hab. yes / no
)f Project/ Activity
ock) length X
'1(s)-
pier(s)
length
umber
:ad/ Riprap length_
vg distance offshore
lax distance offshore
channel
ubic yards
imp
>use/ Boatlift13
Bulldozing
`A Al 1
ine Length
not sure ye.
tgs: not sure ye.
)rium: n/a ye.
ye:
Attached: ye,
ling permit may be
Street Address/ State Road/ Lot #(s)
Subdivision N P
CityLJ' &-P kSU +c}(Gt l4. ZIP G
Phone # (1 I C) 4 3-C�1 Z. River Basin ' `) l
Adj. Wtr. Body V W SU Y.I A CV,6 (,at
Closest Maj. Wtr. Body A (LJL'J
(Scale:
i i 1'711.%, n . J -. .f I I I . . I ,.n _ I C I— I _f f

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: jjtN / l
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
fil-�A611Y-67 d O N « Q44 CaLt iT/ , GT(07A
lwner's Mailing Address:
6miS
Ksc*
��_,
iV
27539
hone Number fj l ) S23 - 91-13
Agent's Mailing Address:
P b- I�oX 5b24
r,C4 -nr 79LI K&d Kb
Phone Number (9) 4+3 _0 8)1 Z
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
>r and obtaining all CAMA Permits necessary to install or construct the following (activity):
,ny property located) at a T
Z$
'his certification is valid thru (date)
Property Owner Signature
Date

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YOUR LABEL NUMBER
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STATUS OF YOUR ITEM
DATE & TIME
LOCATION
FEATURES
70091680000238023892
First -Class MaiP
Delivered
March 25, 2013, 1:10 pm
CARP, NC 27511
Expected Delivery By:
March 13, 2013
Certified Mail -
Available for Pickup
March 21, 2013, 5:19 pm
CARY, NC 27511
Notice Left
March 12, 2013, 3:28 pm
CARY, NC 27513
Arrival at Unit
March 12, 2013, 7:36 am
CARY, NC 27511
Depart USPS Sort
March 12, 2013
RALEIGH, NC 27676
Facility
Processed through
March 12, 2013, 1:36 am
RALEIGH, NC 27676
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Depart USPS Sort
March 11, 2013
FAYETTEVILLE, NC 28302
Facility
Processed at USPS
March 11, 2013, 6:18 pm
FAYETTEVILLE, NC 28302
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Dispatched to Sort
March 11, 2013, 6:02 pm
OCEAN ISLE
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BEACH, NC 28469
Acceptance
March 11, 2013, 11:29 am
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BEACH, NC 284M
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US MAIL
CERTIFIED VIAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
lame of Property Owner:
NkA R2 G k--tZtr �I E k-n-A
.ddressofProperty: l-S$r \ti�, 1Rp —ST, OCEkK, _L..SL.E 2ENC. ' NC.
(Lot or Street #, Street or Road, City & County)
.pplicant's phone #: q lq - ..513- q 1 � 3 _ Mailing Address: 5e I S �� Ay k Faw K
N C_ 11-1539
hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
as described to me as shown on the attached drawing the development they are proposing. A description of drawing,
,ith dimensions, must be provided with this letter.
9��,have no objections to this proposal. I have objections to this proposal.
ryou have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
i writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Vilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
onsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
ppropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
Proper Owner Information)
4nature /�
o I - A GE►1! T
'rint or Type Name
mailing Address
(Riparian Property OwnerInformation)
Signature
Print or Type Name — +k c
lo5tog_
Mailing Address

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VZAE P-11%wo-om 3� I

escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
fund in your Habitat code sheet.
ibitat 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 FINAL Feet
(Applied for. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
II 11
bW Dredge ❑ Fill ❑ Both ❑ Other X
3�3
31-3
edge ❑ Fill ❑ Both ❑ Other ❑
dge ❑ Fill ❑ Both ❑ Other ❑
dge ❑ Fill ❑ Both ❑ Other ❑
gDredgeCl
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 ❑

YERS CONSTRUCTION
P.O. BOX 5024
ISLE BEACH, NC 28469
[phone]
�MNCM MMItIMO AN�� CoM
NORTH CAROLINA
66-112-531
n
0
DOLLARS r
0