62598D - Love

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CAll / —DREDGE & FILL
GENERAL PERMIT Previous permit#
—'New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
arized 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
(� y Rules attached.
nt Name L . C l"1 VG Project Location: County &J, JNStl1 k ( 4-
s S 1 COU 1' Street Address/ State Road/ Lot #(s)
State_ zip
# �) Fax # ( ) Subdivision
zed Agents Ci 1 ZIP
❑ CW Q EW X PTA ❑ ES ❑ PTS Phone `# E5qC) 691 River Basi" V
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ��y^I f
Adj. Wtr. Body W`-f1 Gtr (nat
PWS: ❑FC: ^ e, , ;,
yes / no PNA yes / no Crit.Hab. yes % no Closest Maj. Wtr. Body (-�[ Wes)
if Project/ Activity
(Scale: ' ��
ock) length
X 171 "A x
pier(s)
ength
umber
ad/ Riprap length
ig distance offshore
iax distance offshore
:hannel
ibic yards
mp
use/ Boatlift
atAdozing
o� x
ne Length A j
not sure yes
gs: not sure yes no
,rium: n/a , yes. no
�. Y n
Attached: yes f
ling permit may be requirec

Applicant: L �
VVIvQ Permit #: ( n 9/1 Z S 1� D
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Found in your Habitat code sheet.
TOTAL Sq. Ft
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
labitat Name DISTURB TYPE Disturbance total
disturbance.
Disturbance
disturbance.
Choose One includes any
Excludes any
total includes
Excludes any
anticipated
restoration
I
any anticipated
restoration and/or
I
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
W Dredge ❑ Fill ❑ Both ❑ Other b'
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 ❑
Ix5- 20

BULKHEADS 62-129
IOTHY HOLDEN 515 203 5477
RS NCDL 5202642
MNE RD.
IIl ? _ 4Shidd'
2846 "
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8462
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The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below: The CAMA General Permit application pmucd +res squire that applic im provide the-Divisi
Comml Management confmnapon that a wnuen soatement has been obained signed by the adjacent rip>nm property
indicating that they have no objection to the proposed work S that the adjx nt riparian property owners have been rK
by certified mail of the proposed work Often these fomu are submitted to the adjacent riparian property owners by e
contractor or other individuals acting as an authorized agent on behalf of the applicant.
This form was sent to you by the following iwdWMval or company designated by the applicant as as
atttborized ag Tn I ' ^
Name of Individual Applying For Permit» %L Al - , 11 ,� t- 6 2 t i
Address of Property_ / X.,)-, s6a/.4 C r V / 4.t�=-->
(Lot or Street d. Street or Road)
LZI, 240-a I
(City end County)
1 hereby certify that 1 own property adjacent to the above-refercrtced 'property. The individual applying for I
has desen'bed to me as shown on the attgched drawing the development they are proposing. A description o
with dimensions. should be provided 'with this letter.
I have no objections to this proposal.
It"you have objections to what b being proposed. please write the Division of Coastal Manage
Cardinal Drive Extensions, Wilmington. NC 28405 or call 910-796-7215 within 10 days of receipt of i
No response is considered the some as no objection if you have been notified by Certified Mail.
WAMR SECTION
1 understand that a pier. dock mooring piinngs. breakwater. boat Moose or bout HIM must be
ruiaimum distance of 15' from my area of riparian access - uahm waived byim�e,. (U you wish ti
setback, you most initial the appropriate Mask below.)
9 1 do wish to waive the 1 S' setback requirement_
AV N- WA
t win nnr wish rn tunawr. rho- 1 4' efrh"L- ro-maimmnnt

_k
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
[dame of Property Owner: :� . �-✓�, / � f C—
Address of Property: / y 2
Applicant's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
1 hereby certify that I own property adjacent to the above referenced property. The individual applying for this 1
has described to me as shown on the attached drawing the development they are proposing. A description of dr,
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 (D
in writing within 10 days of receipt of this notice. Cbrrespondence should be mailed to 127 Cardinal Dri-,
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No respons(
considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTI0
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum dicta
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial tJ
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)
Signature
Print or Type Name
Mailing Address
Property
Print or Type Name
Mailing Address

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