62552D - Nunalee

CAIVIA / 'DREDGE & FILL , /
N� 62
"3ENERAL PERMIT �/ Previous permit#
'New _ Modification - Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources / /�
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / r/ . 0
❑ Rules attached.
it Name JAY Ny �Jf 7-4eZF`. Project Location: County /1�77wuz
ilk ;JI �1/ ---State N6 ZIP_
(_ ) i' Fax #( )--
zed Agent n
d CW EW PTA ES PTS
C OEA HHF - IH UBA ❑ N/A
C PWS: ❑FC:
Street Address/ State Road/ Lot #(s)
Subdivision
City 2ll IZ & AW ZIP ! b4
—4�_J-
Phone # ( ) River Basin P408
Adj. Wtr. Body m LO i2��i�(� �K !n'a�
yes / no PNA yes /riot' Crit.Hab. yes / no Closest Mal. Mr. Body,
A Project/ Activity
� (Scale:
lock) length
-m(s) i, Y 121 1 L A VNVI t. 1 V1 I I C. - n: i
length
lumber
!ad/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards
amp
)use/ Boatlift
Bulldozing
❑ See note on back regarding River Basin
i.' i : 1Ja C --1 c a

kpplicant: TA-MC5 JAY NIIV M OtAIA' Permit
)ate:
iescribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Fund in your Habitat code sheet.
abitat 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)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
(
Dredge El Fill El Both El Other �
Z
J "Tz-
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 0 Fill ❑ Both ❑ Other ❑

805
66-887MI
Date
$ d
Dollars 8 o•s'r; :.
.M
41
iLL19217n, 0805

M DOPES CREC--I<
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 3'A(LIC s �y9 `( 1V&4PJ A Uf
Address of Property: gSC1 1 P L qJ L:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: T-'A�u 10 lti/c o6
Agent's phone #: `910 - L47 0 - -) (cl-W ,
Mailing Address: 1)33 ASf 7V.-J L,?KC-
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.
V 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 / I do not wish to waive the 15' setback requirement.
(Property Owner Information)
S
Signdt e
Print or Type Name
(Adjacent Property Owner Information)
Signature
Cy9t&&LCf PTK
Print or Type Name
-/4fC0 1? R I P«C br1
Mailing Address
V1941
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 3 k4q NUN41
(Name of Property Owner)
property located at �a �'v/Prhh"' LN.
NlooRES (Address, Lot, Block, Road, etc.)
on �t'L�K , in en/c 4 6 ,G. P47W -a eO, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above lol
i/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must Fill in description below or attach a site drawl
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
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 Information)
r �
Sigp-tat ,e
Print or Type Nam
f; Z-/ ? "I
(Adjacent Property Owner Information)
Signatur
Print or Type Name
ILJ 0 1 lnn\. C i

Afi
'A
A ra
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
McCrory Braxton C. Davis
overnor Director
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date: - 2 1
ie of Property Owner Applying for Permit: Name of Authorized Agent for this project:
J 1+MES 11qy AJIl& d D,4 V I b "cob
ier's Mailing Address:
(no,v R IPuz-- a2,
.� 1Lrr►1 nICTbN � /� e �.
Z &40 S'
ie NumberM Ip icM-143 6
Agent's Mailing Address:
33 f9S t-t ioN L ii,-c-
BL-(i-1 6q0� N . C, Z $tiZS
Phone Number (q10) 470 - 7 (o ) (,o
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
nd obtaining all CAMA Permits necessary to install or construct the following (activity):
C7 PI EW Cat Zil30 PRoPc rV
AT 4SP-3C4fV1PW L.9NE
my property located at ASV -_'yLl^y 1 PCie LANE
certification is valid thru (date)
Y1
roperty 15wner Signature
1=-2-1 G/3
Date