62654D - Phillips

ie.
cAMA I DREDGE & FILL "
62
EN ERAL 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
Coastal Resources Commission in y,ar,2k of environmental concern pursuant to I SA NCAC i
❑Ryles attached.
t Name VV / rk4 ,, =� Project Location: County
�j,6•? ��'� ! rai Street Address/ State Road/ Lot #(s)
---State I" L ZIP C, .
!(,) - 31-7� Fax # () Subdivision
zed Agent �rAb l rn D r, City ✓ C-! ZIP /r c
d CW EW PTA ES PTS Phone # ( ) River Basin
OEAj'�l�
HHF ❑ IH `❑ UBA N/A Adj. Wtr. Body 11f
PW W" If ai le na
PWS: _ FC:
yes / no PNA yes / no,) Crit.Hab. yes /�fi�o Closest Maj. Wtr. Body
Df Project/ Activity
lock) length
.m(s)
pier(s)
length
camber -
:ad/ Riprap lengi
vg distance offsl
nax distance offi
channel
ubic yards
amp
)use/ Boatlift
Bulldozing
e
ine Length
not sure
igs: not sure
>rium: n/a
Attached:
(Scale: / "-
ling permit may be required by: 5 v G, ❑ See note on back regarding River Basin

Acant:
e:1Z —3 I-3
Permit#: 6Z65 f
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
�itat Name
6 (0)
DISTURB TYPE
Choose One
TOTAL 5q. 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
1
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 ❑

ORI CONSTRUCTION, INC.
252 ENNETT LANE
BankofAmericai
ACH R/T 053000196
66-19-530
2567
SNEADS FERRY, NC 28460 1 / 1 '6- -'B f z�s 12
0
s �Voo
//0 // ,P (l /l i�/(� I l�(� DOLLARS t
N
8
UTHORIZED SIGNATURE
ii'002567ii' 1:053000L961: 2370L53377t,8i''

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Applicant phone #
(Lot or Street #, Street or Road, City & County)
Mailing Address: o�5a E' I&� A
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 pr9posing. A description or drawing, with dimensions, must be provided with this letter.
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. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. 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 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.)
1
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
11,11(I.
Pnnt or Type me
�I �(0Q SN J3 (J 9T
AAnilinn Arlrlrncc
(Riparian Property Owner Information)
: � �1
�ttJ
Signature
(� (�"o _ t--7S
Print or Type Name
.0 Lfb0(- ui )f� c_
AA.�il:nn A.J.l.v.c.o m .�w.�-

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
ya
, "-w s,
fi#ILL-'a
I hereby certify that I own property adjacent to TV �'N'�i� s
(Name of Property Owner)
property located at �Q " �l 11RV
Gl Sy ' N
Address, Lot, Block, Road, etc.)
on �"V,4 in Siik-f 4517-4 / t'�7)ISL.GN.C.
(Waterbody) (Town andloe County)
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
� J
Print or Type Name
Telephone Number
61-�-i�
Date

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
1A J.-, I -� /Y f- A191 L t J P--�
I hereby certify that I own property adjacent to 176AI P- "4111 's
(Name of Property Owner)
property located ato���N7W sc!
Q Address, Lot, Block, Road, etc.)
on �>q�A L_ ` c( F �- ® f L� �l N.C.
in
(Waterbody) (Town andforCounty)
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Ty Name
Telephone umber
Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT. AUTHORIZATION FORM
I -) '?
--j - ,,C I >
•operty Owner Applying for Permit:
idress:
3irl j
, 35 j '71,'
gat I have authorized (agent) Al
L",� "a - to act on my
• the purpose of applying for and obtaining all CAMA Permits necessary to
construct (activity).
3perty located at)
Acation is valid thru (date) .� ) 0
—IL

a
i