61583D - Lassiter

CAMA / DREDGE & FILL A�
3hENERAL PERMIT ✓"�6 Previous permit#--�j'--
New Modification . Complete Reissue Partial Reissue Date previous permit issued •z
-ized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules rtached.
t Name �l//��r'--s 1 -4'ar XOT Project Location: County f Dltf C
' ry Street Address/ State Road/
Lflt #(s)
_ Stated/ ` ZIP G 7� . iZ: `'-
,S��Ybl F�aax# ( )
!d Agent if
Id CW EW PTA F4S E PTS
OEA HHF I UBA ❑ N/A
PWS: FC:
Subdivision
City �/'/
ZIP
Phone #)^'` �,G River Basin
Adj. Wtr. Bodc' (Hate
yes / no PNA yes / no Crit.Hab. yes / Closest Maj. Wtr. Body / ! l�'�'y+'0 SGYJ%'t.G�
A Project/ Activity I/H E 01— Q �� 4A
4'� A / / • (Scale: ro
lock) length
m(s)
pier(s)
length
umber
gad/ K.prap length
vg distance offshc
iax distance offsh
channel
ubic yards
imp
>use/ Boatlift
Bulldozing
ne Length
not sure
gs: not sure
wium: n/a
Attached:
ling permit may

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SHIPPERS OF QUALITY HARDWOOD & S.Y. PINE
1401 St. Stephdns Road TEL. [phone]
PRICHARD, AL 36610 U.S.A. FAX [phone]
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SHIPPERS OF QUALITY HARDWOOD & S.Y. PINE
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1401 t. Stephens Road TEL. [phone]
PRIC ARD, AL 36610 U.S.A. FAX [phone]

2012 10:13 From:
To:9103272387 P.2
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: J *Alt W,1 4L4S S i lea
Address of Property: qol � q4"' !��P&W C IV &L
(Lot or Street #, Street or Road, City & Coun
Agent's Name #;
Agent's phone #;
Meiling 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—rnuat he provided with thia_la_tteC.
I have no objections to this proposal. _ _ _ T have objections to this proposal.
If you have objections to what is being proposed, you must notlfy tho Division of coa8tal Management (DCM) in
writing within 10 days of receipt of this notice, Correspondence should be mailed to 127 Cardinal Drive &t„
Wilmington, NC, 28405.3845. DCU ropro8enta0ves can also be contacted at [phone]. No rosponse in
. mnai.4orad thn Rama as no oblecdon if you have been notified by Corti ied Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be sat
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you M149t lnlgpj the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement,
operty Owne nformatl )
ignature
J A'a4.t?s
1 ✓ 'J� I ly
Print or Type Name
(Adja nt Prop Owner Informatlon)
S'A
Signal e
Print or Ty e Name
Mailing Address

2012 10:13 From: To:9103272357 P.2
CERTIFIED MAID. RETURN RECEIPT R.EgUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: �JAA(S - L41S 1 a
4103 2- � �S-f �a4 C-4 , Ke-
Address of Property: -
(Lot or Street #, Street or Road, City & County)
Agent's Name #; Mailing Address;
Agent's phone #:
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 drswing the development
they are proposing, A description or drawing with -dimensions moat be provided with thin igAr.
I have no objections to this proposal, _ T have objections to this proposal.
I/ you hovo objections to what Is being proposed, you must notify tho Division o/ coastal Management (OCM) In
writing within 10 days or receipt of this notice. Correspondence should be mailed to 127 Cardinal Drlvo Ext.,
Wilmington, NC, 284054845. DCM representatives can also be contacted at [phone]. No response 1e
considered the same as no objection I/ you have been notified by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 1 T from my area of riparian access unless waived by me. (if you
wish to waive the setback, you mHP1JDLU8 the appropriate blank below,)
I do wish to waive the 15, setback requirement.
I do not wish to waive the 15' setback requirement,
operty Ow r 1 ormati )
- 1
rgnature
Print or Type Name
(Adjacent Property Owner informatlon)
Signature
�� L i d 0�-5-se a t
Print or Type Name
Mailina Address

cant S Gl _ SC / � Permit #: s-0
L
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ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
t Name Choose One 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 �0
�U
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Fill ❑ Both ❑ Other ❑
FDredge
Fill ❑ Both ❑ Other ❑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 ❑

1ES A. LASSITER 66-704/2531 2009
LIC.5551935 sf
P.O. BOX 2363 3
ITHFIELD, NC 27577 DAr L
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3' Credit Union•