61514D - Robbins

LAMA / DREDGE & FILL
E N E RAL PERMIT Previous permit #
New _Modification Complete Reissue El 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 15A NCAC 1
1 Rules attached.
it Name b4 ✓t v
:�. �,.f,�-j�;.,,-, _ _ Project Location: County
I_� I i..-r , _ Street Address/ State Road/ Lot #(s)
State t-­- /_ ZIP
+ Fax # ( )
!d Agent _' / r. f �, <y1 C�-1Ci--'
d CW EW PTA ES PTS
OEA HHF I UBA - N/A
Pws' FC:
Subdivision
IF
City \ j lam` w 1 Su (/4 & L lei ZIP ? P
Phone # (� Ip )5 ► �I�rS River Basin L_01-11t
Adj. Wtr. Body r'`CI ,U)ici (nat
yes / no PNA yes / no Crit.Hab. yes / no
Closest Mai. Wtr. Body �l W L J ~�
A Project/ Activity I IC.�1►G c
(Scale:
lock) length
m(s)
length
umber
:ad/ Riprap length - S
vg distance offshore
iax distance offshore
channel
ubic yards
imp
)use/ Boatlift
Bulldozing
>s`n%QPeD ArtaA
S x j _`'
ne Length S
not sure yes ( no
tgs: not sure yes ! o
)rium: n/a yes no
yes,; no
Attached: yes no
ling permit may be required by- lW n 4 Co o rt [stc ❑ See note on back regarding River Basin

V15/2011 04:27 9105799096 GRICE CON
North Carolina Department of En ronmerit and Natural Resources
Division of Coss Manasement
Beverly Eaves perdue `affm H. reg°n
Govemor Dk for
Date: A l G. I 1
Name of Property Owner /Applying for Permit:
f�'DVD/Nf
owner's Malting Address:
! 8ba1 M )ecro�-f Ca kc. Lake
r Jv, cute NG 210316 `
Phone Number,[i�41 yd�
i certify that l have authorised ,tA agent listed above to
for and obtaining all CAMA Permits necessary to Install
(rny property located) at
This'certiflcetion is valid thru (date)
Props Owner S18nature
of
Mailing Addres
PAGE 01
Dee Freem
Secrete
for this project.
Phone Number. > ..
pact on my behalf, for the purpose of applying
or construct" following (activity):
v A,,� Ism �E
1)-Lt.- I 'Z
Date

RIL
CERTIFIED MAIL - RETMN-RECEIPT RE, QUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 l
hereby certify that I own property adjacent to
''`l� C_` (Name�IP erty-ty located at � 1)�K���1
(Lot Block, Road,et
L �5 �-11 , in QQ-Q-�-lr -Q , N.C.
(Waterbody) _ (Town and/ 721b
o"
,.ant's phone #: cA t 13; S-1 st - c t Oct 1 MailingAddress: &,Qch
has described to me as shown below the development he/she is proposing at that location,
lave no objections to the proposal.
DESCRIPTION AND/OR DRAWING-OF�ROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing
10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
representatives can also be contacted at [phone].
No response is considered the same as no obiectlon if you have been notified by Certified Mail
erty Owner I for ation)
ture `-
or Type Natne
ng Address
(,AA �4 L 2S'y3 b
(Riparian Prope owner Information)
Signature
Print or Type Name
Mailing Address

ANu utLivtK
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �' t ma's
(Name of Pr perty Owner)
proper
ty located at
(Lot, Block, oad, etc.) t
on --1- in J�� N.C.
(Waterbody) (Town and/or County)
c < �
Applicant's phone li:yMailing Addrets:�< <"
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his prWsal. —Tk--
------------------------ --
----------------------------------------- -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
---------------------------------------- -* % --------------
(Information for Property (]!'her Applying
or Permit) ^
WcA Y\C4, MailingAddress
LAN
y
(Riparian Property Owner Information)
II II S�ture
Print r%r I'vnP. NgM6

O&�
Jam'' I, uhrud
\�.� me(- � �6�b\ �,5

pplicant:
ate:
Permit #qp l J l 1
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
.bitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternimpacts)
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 ❑
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Otherx
S
la
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 ❑
15x 50.5 =

> items 1, 2, and 3. Also complete
Restricted Delivery is desired.
r name and address on the reverse
/e can return the card to you.
its card to the back of the mailpiece,
i front if space permits.
dressed to:
\'L ILI���
A. atur)
X Si� C � gent
JJNJJ It] Addressee
B;.�Received by (Printed Name) C. to OWDelivery
(" N i C
D. Is delivery address different from item 1? Yes
If EN7tdelivery address below: ❑ No
3. Se e Type
Certified Mail ❑ Express Mail
❑ Registered -t%fietum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
mber - — -
rom service label) 7 012 2 210 0001 7862 5503
311, February 2004 Domestic Return Receipt 102595-02-M-1540
U.S. Postal Service,.
CERTIFIED MAIL,, RECEIPT
(Domestic Mail Only: No Insurance Coverage Provided)
For delivery information visit our website at www.usps.com
Postage
$
CertNied Fee
Ijb
ReturnReceipt Fee
(Endorsement Required)
Postmark
Here
Restricted Delivery Feei1,
(Endorsement Required)
l)0
fb.il UI/UL/2Uls
Total Postage & Fees $
Sent To
--------------- - 1 -5 -------------------------------
Street, Apt No.;
or PO Box Ny �o �((� � � It-
------------------
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/�- -( ---
City, e, ZIP+4 I �(
PS Forin :12006 See Reverse for Instructions
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