61616D - Painter

CAMA / ❑ DREDGE & FILL
/�
/A V Flk(
3EN ERAL PERMIT
Previous permit #
11�lew ❑Modification -Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources j
0 Z
:oastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC 1{
ules attached.
�y
t Name {JeA, f� f' f le,
Project Location: County�fn ,,
4
Street Address/ State Road/ Lot #(s)
l Ii f State_ke ZIP 2svI !
J, 1 Aee- /`
Fax # ( ) --
Subdivision
:ed Agent
City /,.V/ f1-0rZIP 2A2 ,
❑ CW pigW PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
rr
Adj. Wtr. Body (nat h
es ) no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body ,061
If Project/ Activity
,ck) length
rier(s) r
:ngth
amber
id/ Riprap length
g distance offshore
ax distance offshore
hannel
ibic yards
mp
1
,z Boatlift 3 X
3ulldozing
ne Length % !O!w
not sure yes Do '
gs: not sure yes
orium: n/a yes n9
a-
yes " 1
Attached: yes F,
ing permit may be required by:
.— - -— --- il.aI..
tln'A-, oil / Gr..� s /i
1At
f�
U See note on back regarding River Basin

North Carolina Dspartrrwnt of Environment and Natural Resources
Division of Coastal Management
Rat M�,Crwy aMA M C. Davis John E Skvada, llt
Governor Director Secretary
AGENT AUTHOE11ZATION FORM
Date:/AT �?a
tine of Pfty Owner Applying for Permit: Nam* of Authodz— Agent for this project:
*aii 's AIM Add ssr
ads �, r dB 1
0hona Number 919 1 6 A- 5 YDS
Agenre Unift Address:
�'.NC za
Phone Number f
certify that 1 have authorized Ow agent listed above to act orr my behalf, for the purpm of aDRhAn9
sr and obtaining afi CAMA Permfta naammry to Meta or core nct ttm tottowing (adlvty):
Ig�)r,�l&r ACi'Aes oh 14Y ars 'W6W Ad r'140t �BFf a '
n
'or MY propa4Y focaw at .33
Property Ownw ftnatum Daft

DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FOR]
Name of individual applying for permit 1✓ L"' �� �'h"
Address of property V Y! • ��'u'- ��1 �� t L d B�`�►
I hereby certify that I own property adjacent to the above refemneed property. TI
individual applying for this permit has descdibed to me as shown on the attache+
drawing the development they are proposing. A description or drawing, with
dimensions should be provided with this letter of notification.
Please initial below if you have no objections. AAft $OK&
I have no objections to this proposal. pn S�► ��'/�bxf
,g�Q �t'f f�
if you have objections to what is being proposed, pf✓eaae write the Division of Coa
Management 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 811
AAwithin 10 days of receipt of this notice. No response is considered the
7Jj ;b%jf3 same es no objection if you have been notified by Cert1W Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must be set back a minimum 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.)
l DO wish to waive the 15' setback requirement.
] 00 NOT wish to waive the 15' setback requirement
\ Stgnatu re & Date
V it .-1-- L)-1)-4, -265:2 Deist Noma

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FO
Name of individual applying for permit &yn 41471?YL
Address of property ' / L &
I hereby certify that I own property adjacent to the above referenced property.
individual applying for this permit has described to me as shown on the attach
drawing the development they are proposing. A description or drawing, Witt
dimensions should be provided with this letter of notification.
Please initial below if you have no objections.
_
I have no objections to this proposal. Pdmif 40 40X
A Jer l491 n StaP
if you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 9
30 within 10 days of receipt of this notice. No response is considered t'
776 9AIS same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must be set back a minimum 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 DO NOT wish to waive the 15' setback requirement.
Signature & Date

ale earth
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300
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1pplicant:l�►
)ate. LE J/ 3
Permit #:
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet.
DISTURB TYPE
abitat Name 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)
W
Dredge El Fill ElBoth El Other �-1"
2 r (a
Z 61
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 ❑

.. ... . ....
%ND S MARINE CONTRACTORS INC. . . .... ... ....
P-0-BOX 868 TEL[phone]
WRIGHTSVILLE BEACH, NC 28480
15-3/540
r-11 893
DATE P
Ak ,IV) s C 0-�'
DOLLARS
BANKo.
040