61585D - Roberson

CAMA / . DREDGE & FILL n'
3"ENERAL PERMIT J Previous permit# r
]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued -�-
Ozed 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
❑ ules attached
it Name � U SG/,i
o l`•1 .1 State Nc- zip Zit S�
l )�/ p - Sy Fax # ( ) w
zed Agent _-,� %��7 /
❑ CW 'C EW -.� PTA 'I ES LL PTS
OEA HHF IH UBA P N/A
C PWS: ❑FC:
yes / no PNA yes no Crit.Hab. yes /U
Project Location: County, ii -� ( U W —
Street Address/ State Road/ 'ot #(s)
L tf �
rU66 r
S-�
Subdivision
City Sv / ,(- 6-tit, zip
Phone # ("' River Basin
Adj. Wtr. Body !� ✓1A �S /r+ SG na
Closest Maj. Wtr. Body �v
f Project/ Activity j/y'1 �j �Gf%' ���
'r S 0
xk) length -----------
n(s) 14- x Z !t
)ier(s) Z ` -S, Y V f
angth
amber
id/ Riprap length
g distance offshore
ax distance offshore
hannel
bic yards
-np
ise/ Boatlift _
lulldozing
ie Length
not sure yes no
,s: not sure yes no
-ium: n/a yes np
yes rflo
Attached: yes no
(Scale:
ing permit may be required by: JA I ❑ See note on back re g ding Rivfr Basin r

IT
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ILA 3
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) & : nn IZi (�D1/1S - lIq to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity), ift d &Ly ) dea ,bt�A 1&-fst
at (my property located at)
This certification is valid thru (date) Z I 'ZQ
11��3
Property Owner Signature
Date

I I Ir. IiIII s'vr
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:�Y j _
Address of Property:
A-V\
(Lot or Street #, Street or Road, City & Cou
Applicant phone #: 1nS Mailing Address: 9JID-a hny0 - '
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 proposing. A description or drawing, with dimensions, must be provided with this letter.
I 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.neticontact- 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
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.)
�l I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
(Riparian Property Owner Information)
- -- -- --
Signature
CP
Print or Type Name
Mailing Address
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: l i lam. l�u.�c-ts130
AVUr ess of r r opel ly:
A r
(Lot or Street #, Street or Road, City & Cou
Applicant phone #: flxIhV1-i\j • eb03NdIDA Mailing Address: _��a Fid ✓lr ft- l.Y! -
'IQ 331 �305- tM
i
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 proposing. A description or drawing, with dimensions, must be provided with this letter.
k!!!!�. 1 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.nccoastaimangement.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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
(Riparian Property
Owner Information)
Signature
d 06&e H T c-I 4 /As
Print or Type Name
_rZI-11111 e6:559� S'X
Mailing Address
Mailing Address

f ►'`4 ���

cant:
Permit #: ( ( 5s-
-Jibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft.
(Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance_
it Name Choose One includes any Excludes any
anticipated restoration
restoration or and/or temp
temp impacts) 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)
J-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 ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

2260
)NSTRUCTION, INC.
2 ENNETT LANE
S FERRY, NC 28460
Bank of America.
ACH R/T 053=196
66-19-530
0
y�` A IZED SIGNATURE