61597D - Rabon

'4
�CAMA / ❑ DREDGE & FILL
3"ENERAL PERMIT Previous permit #
New -Modification [-]Complete Reissue -Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC —7H ; (tjwo o Q
nn -- ules attached.
it Name 11r 1. K..m _�,O NJ Project Location: County U.0 lS V'/ j C 14.
40 4 W , M WN WICV- Street Address/ State Road/ Lot #(s) PM(kJ,**
State NC ZIP2 _ 5�- � ��{. OAVAS4� i(1-
`Ai—o)4L'J-(pJ]5 Fax # ( ) Subdivision
:ed Agent `fi OM Nm PL--Yz2.y_ /� MIsR! G� N j�Lft j ri,. " City s UTt�T'
ZIP_
❑CW ❑EW L?PTA —ES ❑PTS Phone # ( ) River Basin ( P'rl-L—
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
El PWS: El FC: C
Adj. Wtr. Body A iw V\I CNP/
7
yes /&fbi PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body I w V J
F Project/ Activity I rlSTftt 1, ELLA- 11-1 � i- I aEX- e I tl2 N I-rP11 J �i(. I S`i 1 N(e �L
(Scale:
,ck) length
1(s) t
iier(s) I� / X ! �- 3 1
!ngth
tuber
d/ Riprap length_
g distance offshore
uc distance offshore
cannel
bic yards
np
i �sE/ 66atlift 12!X12
ulldozing
e Length 31 'tt
not sure yes
s: not sure yes c
ium: n/a yes nc
yes nc
kttached: \ V no
ig permit may be required by: jCi��'r2T
❑ See note on back regarding River Basin n

American Fisn Company
0 Box 1 1046
RJ
iuuthOOR. North Carolina 2846 E
" Email AFC0360*Qao► corn
.J10► 457-5488
13101 45; 6551 Fri,
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31.72

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Name or Individual Applying For permit:�.% j I I t�Rat on
Address of Propem, unSw
tLot or Street 4. Sttftt or Road)
_ S out po 1,
'City and County}
hereby certify that I own propen�y adjacent to the above-reft.encea vro cr-�..
apply=ins for this permit has described to me as shown on the anachea draw;rp � The andividw
are Proposing. A description or drawing, with dimensions, shovid be c-o�-� -d �� the
d r.� wigs ker
have no objections to this proven;
U you have objections to what is being proposed, please watt the D+��,,,n of Cods
Management, 127 C�rdiaal Drive Extaaaioa,
witbin io days of recaipt of this notice. No responise s considered the sa r r s `'1'?9b-72t
You have been notified by m@ a5 n� p ni
. Ctrtif3ed Mai{
WAIVER SECTIO
l understand that a pier, dock, mooringPilings,breakwater, tiont rouse or boa: lift
bcR s minimum distance or i y from my area f riparian access - un,,ess �. t1 Y�tbes�
'isb to • 3jve !he sctbaclt, you must ialtfoi the appropriate blank be1n« "• ed b. me. (Ifyo
\ C,---- co wish to waive tha i se'back reouirement
t ?3 `a lsn to ivaivZ ti,c i S gctba;i; reQvitement
not dame
lIKX-AVA

I
Name or Individual Applying For Perrait: � t '� �CtR
----
Address of Propenty i j e+ `-{ �` 4n _e i 5t
(Lot or Street is. Street or Road) ^-
;City and County)
hereby certify that I own progeny adjacent to the above•refercneea aroper -. The individut►1
appl}'ing for tr=is permit has described to me as shown on. the amched draw -mg :ne devek*nv
are proposing. A descripEjon or drawing, with dimensions, should be crov ded w+ththis ►der
I have no objections to this propcgaI
tt tou have objections to what is being proposed, please write the Divis"0a of Cotes
Management, 127 Cardinal Drive Extension, Wilmington, INC 28405 or call 919-79d-7Z1x
within 10 days of recalptofthis notice. No response is considered the some as no otle&6nil
�•ou have been norified by Certified Mall
WAIVER SECTION
I understand that a pier, dock, mooring pilings, bronlovater, cant house or boa; (;{ttttiust be se
bcka minimum distance of 15, from my area of riparian access - unless waived by retie. (ifyo,
Wish to Ivoive the setback, you must initial the appropriate blank betnw
{ eo wisn to waive the 15' setback renuireme►+t
amr
1 OR - Wish to waive the 15' setback rrqu►remcnt
bate.

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ` o
Name of Property Owner Applying for Per it:
xj /l_
Mailing Address:
I certify that I have authorized (agent) I J ✓n �) 7` �� r�` to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) (36a:� !— V-6
at (my property located at) 46 W
This certification is valid thru (date)
Property Owner Signature / / Date

rplicant: { L M n Permit #: (�
ite: 7/
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
jitat Name
TOTAL Sq. Ft. FINAL Sq. Ft.
(Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance.
Choose One includes any Excludes any
anticipated restoration
restoration or and/or temp
temp impacts) impact amount)
TOTAL Feet FINAL Feet
(Applied for. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
Dredge ❑ Fill ❑ Both El Other
I
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 ❑

AMERICAN MARINE CONSTRUCTION INC
CHARLES H. OR KAREN Z. PERRY
P.O. BOX 11046 910-457-5488 T
SOUTHPORT, NC 26461 DATE-) 13.
�AY
O THE tj \� � �� \\ I f)o
)RDER OF
DOLLAR
v First Citizens
Bank
-OR
1