62661D - Jordan

CAMA / it DREDGE & FILL
-21ENERAL PERMIT
Previous permit #
_New -Modification ❑Complete Reissue El Partial Reissue
Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
-oasta^l R Commission I SA NCAC
sourc in an area of environmental concern pursuant
to
;' !�• r�
it A /t" QY
Project Location:
� Rules attached.
County
Street Address/ State Road/ Lot #(s)
y _ State__ZIP ?� ��
1�G/ ,
T ,r
Fax # ( ) `"""`
Subdivision
:ed Agent ----- ---
city �111 lvH,.-yc
�/� ZIP
Cw Ew PTA '191(SC PTS
Phone # ( )
<'""' River Basin
OEA ❑ HHF = IH UBA f ' N/A
Adj. Wtr. Body
PWS: El FCc
yes /.no PNA fes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
f Projpct/ Activity
ock) length
m(s)
pier(s)
length
umber
ad% Riprap length
vg distance offsho
iax distance offsh,
channel
ubic yards
imp
)use/ Boatlift
Bulldozing_
ne Length
not sure
cgs: not sure
)rium: n/a
Attached
ling permit may be required by- —/N� 1L�1r (�0 - ;FNSy[1/iA�,S ❑ See note on back regarding River Basin

Permit#:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat 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
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 Both ❑ Other ❑
amount)
/
Dredge ❑ Fill V Both ❑ Other ❑
' qD
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 ❑

1
7156
66-112/531
PH 910a91-6010 � I�
Li$ C)d
16
r
'ANY
5 2 1930647611807 6

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
ro erty located at Z `� G/
(IN
P p
(Lot, Blockt Road, etc.)
on�.
_�_v► boyip �'g , in 1,V 6 V/ , N.0
(Waterbody (Town and/or County)
Applicant's phone #: �� aka 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.
------------------------------------------
DE*CRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individ tl proposing development must fill in description below or attach sited wing)
"a
ktA)
:CEIVED
fILMINGTON,
;T U 4 2013
,mow, ltc� Ji�+�Yi''�^�"
J
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Eat. Wilmington,
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
(Property Owner Information)
t hvr-111' k
Signature
"Type M�uPrint oame2-1-lq A) - &" n -t / I
(Ripg-m-n- PropVty Owner Informatioi
Signatme--� v
I5v�" -z-
Print or Type ame
l -qu Al. LAD—Y-
Mailing Address
NAMina Addre—

10/07/2013' 12:55 9107919777
MASONBORO BOAT YARD PAGE 01
RECEIVED
DCM WILMINGTON, N1
OCT o 7 X13
DIVISION OF COASTAL N1k- AGYAUNT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own properr/ adjacent to
property located at Z�%�%w Ct_WA11W I 1 1(' '4m e of Prope'ty O-viner-j
on r zospnbp,-p a (Lot, Block, Road etc,)
in /Uf Lr�r. N C .
(ne#!. firbody) (Town and/or County)
Applicant's phone Mailing Address: S
He!she has described to me as shown belew 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)
/gin ��•/`t��' C'as�� �a
136 11
r�_
If you have Objections to what is being proposed, you must notify the Division of Coastal Management (17CW in writing
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 (910) 796•7215,
No respunse is considered the saint as no objection if you have been notified by Certified Mail
(Riparian Pr arty ovine form9t'6p
Si at!
x
Prtnt cr Tyre name`
(Property O-Amer Information)
f
yll�l
Pnnt or Type Name