62547D - James

P�'dAIVIA'/ 171 DREDGE & FILL
GENERAL PERMIT Previous permit #
eNew !Modification E Complete Reissue -']Partial Reissue Date previous permit issued
Drized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC— #
nt Name r,44e / - - 5, Project Location: County M Rules attached.
Y4/ . , J1,1ve — Akt---
33LO?
5IWe,
A41/4'i Mo State
ivZIP 90W//
ax #
/CW
tv9w�-OTA -ES
PTS
D OEA
El HHF ❑ IH ❑
UBA Ll N/A
E] PWS:
EIFC:
yes no
PNA yes / no
Crit.Hab. yes no
)f Project/ Activity
ock) length
m(s)
pier(s)_
ength
umber
ad/ Riprap length
vg distance offshore
iax distance offshore
-hannel
jbic yards
-)p � �, k 2 �J
'Use/ Boatlift
Bulldozing
Street Address/ State Road/ Lot #(s)
15�-kh,f -,,,
Subdivision 5��d e
oe
City (,V/ zip 1.45
Phone# River Basin
Adj. Wtr. Body (n<
Closest Maj. Wtr. Body
(Scale:
ne Length
Vv- -
not sure yes
gs: not sure Yes
,rium:
n/a yes
no o
Attached: (7-1 &
See note on back regarding River Basin
ling permit may be required by: ZLIV/
/ P, LJ f I ->

applicant:
Permit #:
)ate:
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
vnd 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
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
I FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
(IV Dredge ❑ Fill ❑ Both ❑ Other
w 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 ❑

642
15.3/540
13 Boo
Date
$ Zoo, ad
F..,.n.
Dollars
i
036893Ing 0642 �

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: A
Address of Property: 7
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
&(/ ,Fy o
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 roposing. A description or drawing with dimensions must be provided with this letter.
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 Info ation)
Signature
Alrchac( Q Tj,.-ArJ
Print or Type Name
37 8 J �`"12--'- &.
Mailing Address
(Adjacent Property Owner Information)
Signature
Print or Type Name \
1
Mailing Address , (v

o
U , -T-
Alit
"ALW
VA f 4. M-11�
t:lPt L3AM K ah)F--
5V6
NOM — _EL:*tjA)L-a
u- ME(K
MIOT
jp,f— c-3.'
55
55',lc
)DwAj:3 15
2 63
Fri (�Tp
%

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 41 r
Address of Property: 3 7 19
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
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.
�i
�/; 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 15from my area of riparian access unless waived by me. (If you
wish to wa�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 Info ation)
Signature
14 eC t,ar ( Q. TA --\ 7 J
Print or Type Name
37? 5Awrho:-r &.
Mailing Address
(Adjacen roperty Owner Information)
"`Ti -
Signature
Print or Type Name
4 C�
Mailing Address