60679D - Larson

[�CAMA / DREDGE & FILL No. 60
GENERAL PERMIT Previous permit #
New ❑Modification -Complete Reissue Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources 2
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules ttached.
nt Name ne><� Project Location: County %(%4 ty tK�,Iw
s / 2 9 �,eAh / i e , Street Address/ State Road/ Lot #(s)
{/t// /•-.��,,� State_ ZIPy©
# ( ) y(i Fax # ( ) Subdivision
' ,�t,,
ized Agent �`� City (/V/�wNi�}/��' ZIPOW,
d C CW � A ES -_ PTS Phone # ( ) '5e4#*%/ River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA —1 N/A Adj. Wtr. Body �leC �%ee)e
❑ PWS: ElFC: at'
no . yes / PNA no Crit.Hab. yes / no Closest Maj. Wtr. Body �/40
A Project/ Activity /'e- CO., / !�✓� �X/S fi h
S-1
lock) length
pier(s)
ength
umber
ad/ Riprap length_
✓g distance offshore
iax distance offshore
:hannel
'Ile
ibic
irnp
use/ oatl' " X%3
P'YA"
•"L
Llo
i
-
/y,� 1 - --
ne Length ^"7L-3
not sure yes o +�?
gs: not sure yes
)rium: n/a yes (,o
es no
-4
Attached: no
ling permit may be required by: /�yy �je,�%�y,�i� C !' , ��j�i� See note on back regarding River Basin

pplicant: 7e- i L-.o✓S ('�/J
ate: � �i8�Z(71-3
Permit #: �j -;7
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat Name
V
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 ❑ Both ❑ Other
2 tD 5'
2 ,� 5
Dredge ❑ Fill ❑ Both ❑ Other ❑
ll ❑ Both ❑ Oiher ❑l
❑ Both ❑ Other ❑
F
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 ❑

66-456/531 9543
.ARSON
LARSON DATEJ;��
AN AVE o 0
JC 29403 3524 s o�-QD
DOLLARS lJ
- 0 9 5 � 3
10 2 300 289 -o

CERTIFIED NIAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: Reid LaySDV I
Address of Property: 1 l e C�� l 4114e, Bn Mew�7Q
(Lot or Street #, Street 6r Road, City & County)
Applicant's phone #: Mailing Address: ���vL Wi �Ir�w �poCls �1
k)i[Mih4a,, /UC a9YR
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this per
has described to me as shown on the attached drawing the development they are proposing. A description of drawi
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 (DCP
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive I
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no obiection if you have been notified by Certified Mail.
WAIVER SECTION
l understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
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.)
\)Q41JU do wish to waive the 15' set back requirement. 5 n
I do not wish to waive the 15' set back requirement. i2 �� c e
(Property Owner Information)
S' aturg J
P r
Print or Type Name
-3,;Z ;z, 0,; llmw
Mailing Address
1 911 < e
Owner Information)
eAdA� ;S W �G1-S
rint or Type Name
I;z6 P<c.4cw Alre�
Mailing Address

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: l� � I Cl L
Address of Property:
(Lot or Street #, Street or Road,,kity & County) a g Vo 3
r pp
Applicant's phone #: G]' D " 7q �(' L{D y 6 Mailing Address: �0�02. ltil wllS r
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this per
has described to me as shown on the attached drawing the development they are proposing. A description of drawi
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 (DCP
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive I
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, or lift must be set back a minimum distance
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Sig tore
(2 Cl L4Ys 4'r�
Print or Type Name
Mailing Address
�.)+1 f_ A
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address

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