62502D - Rumbold

CAMA / ---DREDGE &FILL
V101" *19 62
ENERAL 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 an area of environmental concern pursuant to 15A NCAC 'T '� • ' 0 0
Rules attached.
t Name i dj ti '1 Irj ) I j d { Project Location: County:i�(l)Y'SIn l a,
2 t (fit ►bl4'Lt, i a C k at v �u GL Street Address/ State Road/ Lot #(s)
U I 1 lv, State f V i.► ZIP 2q 2-'�7J "Z Ncof 4 6 \ LY► V G
# p) + - 45� ✓ Fax # ( ) SubdivisionN A
izedAgent-; �f1t dC ity
CW ❑ EW ` PTA [) ES n PTS
❑ OEA ❑ HHF ❑ IH UBA _] N/A 1
• Adj. Wtr. Body i
❑ PWS: j7FC: ,�
yes / no PNA yes Crit.Hab. yes / no Closest Maj. Wtr. Body `-�
A Project/ Activity UZAYL i i
ock) length
x
MEMME ■ E■
• �r�PRIM
E �Hi1ffi/ �
■ ■IMMM
■INEMMI■MEM
ne Length r�
not sure yes no�i{/
gs: not sure yes no
rrium: n/a_, yer no
�ye�. n�o
i
Attached: yes /no ; —
ling permit may be required by:
ZIP
O River Basin
(Scale: r
/Y u r l:>Vy I l LA_ n ❑ See note on back regarding! River Basin
\ i ' A 1A A i 1 K-7 d1., 1 11 to A L"if 0-V P

BULKHEADS
DTHY HOLDEN[
IS NCDL 520 2
-9732
MNEY RD. Aff
28462
nk
10 15 7 5 300
915 9203
5211
DATE 7 1/ — / 5

U mbb
Applicant: 1�� l�� Permit #: Z
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.
DISTURB TYPE
iabitat 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/o
temp impact
amount)
soDredge
❑ Fill Both ❑ Other ❑}
SDredge
❑ Fill Both ❑ Other ❑
255
255
Dredge ❑ Fill ❑ Both ❑ Other
50
255Q
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 ❑

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EC-03-2007 10:02 From: To:6429EO6
C�RTIFfED MAIL - f C l ,tF-DU _S'tTFD
• t • ii � u • .� �u
The purpose of this form is to provide proper notice to you as an adjacau riparian property owner to the individu+i :
indMduals iisresi below_ 7U CAMA General Pernnit •pplic"jon pr-_Dcdures mquim that applicw= provide the t)iv
Coasmi Matrngorncnt connfwa afm that a written mi mn eat has been obauned signed by the adj=m riparian prolwn
indicating that they have no objection to the proposed .cork #1 that die adjawn ripwrim property owners have beep
by citified mail of the proposed work_ ofbm these forms are to the adjacent nWinn property owners by
cone -Jaw or other indivklua s axing as an authorized agent on behalf of the sppli mnr.
This form was sent to you by the rotiowing indlvklnal or company desigaated by the applicant as ai
authorized agent
—/-:5
Signature Date
Nana of Individuai Applying Fo Permit: �' J /It C
ikddre3s of Property_ Z h
(Lot or Street -4, Street or Road)
(City
I hereby certify that I own ptopeny adjacent to the above -referenced property. The individual applying fog
has described to me as shown on the am
gctted drawing the development they are proposing A description
/
with dimensions. shou /ld 11t provided vrith this letter,
___ ✓ _ I have no objections to this proposal,
tf you have objections to what is being proposeds please write the Division of Coastal NrlanaE
Cardinal Drive Extension, Wilmington, NC 2840S or call 910-796-7215 within 10 days of , ipt o
No response is considered the same as no objection if you have been notified by Certified MaiL
WAIVIER SECTION
I undemead that a pier, dock. mooring piling, breakwater. bout Louse or bout lift trust b+
minimum dis[aace of 15' from my area of riparian access • u5ba waived by he MA- (lf you wish
setback4 you most initial tappropriate blank below.
I do wish to waive die l S' setback requirement_
I d"a wish to waive the I5' sethaatr rrnitirament A��

'2004 19:20 9108429606
' - • i �! e • ' y4AN - '-k
ame of Individual Applying For Permit:CJ`�✓�
4dress'of Property: 3.5 20 YIP em'gsLt�✓'^-1
(Lot or Streat 0, street or Road, C ty 6 County)
: hereby certify that I own- property adjacent to the above-
:aferanced property- The individual applying for this permit has
iescribed to me as shown on the attached drawing the development
:hey are proposing. A description or drawing, with dimensions,
should be provided with this latter.
I have no objections to this proposal.
I understand that a pier, dock, mooring pilings, braakvater, boat
house, list _ bust be sat buck a minimum distance of 15'
from my area of riparian access unless waived by me. (If you wish
to waive the setback, you mint initial the appropriate blank
below.)
I do wish to waive the 15'setback rnquirement-
�� I do not wish to waive the 15'setback requirement.
CA,d 3tl i3
Si nature DAte
13
Print Name`
clIe-520-2toC) IDIFE

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T S'S M�U
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