61502D - Robbins

❑ CAMA / ❑ DREDGE & FILL f /
GENERAL PERMIT V Previous permit #
4New [-]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
ZI Rules attached.
nt Name Project Location: County it
s Street Address/ State Road/ Lot #(s) L,
04 id vn Stal ZIP Z90?
# 3*k, Fax # ( ) Subdivision
!zed Agent 1 Yi (1 �:i 1StYVth w City �! l (!.�1 kLI li (�� ZIP -"��t
❑ CW ❑ EW LL' PTA ❑ ES ❑ PTS Phone # (1K, C1` 9 ' 5 River Basin 1m
OEA ❑ HHF r IH ❑ UBA ❑ N/A ` j
Adj. Wtr. Body { C' �! V r xi covF k in at
_ PWS: ftC: /�
yes / no PNA yesCrit.Hab. yes '/no Closest Maj. Wtr. Body A
A Project/ Activity
(Scale:
ock) le'nZh L- 1 ^ 1
m(s) I / " it 1 x
pier(s)
length
umber
ad/ Riprap length
vg distance offshore
iax distance offshore
:hannel
ubic yards
imp
fuse/ Boatlift
Bulldozing
ne Length
f • "./O
not sure
yes no
gs: not sure
yes noli
)rium: n/a
yes no
yes no
Attached:
yes • no
ling permit maybe required by - -IL L iyl (� �J�'f�N I �V �% A (�- ❑ See note on back regarding River Basin
. — ij l7i P. n— A nil r.W_ j.-ti.l `I _I n ...1 (-'1, - I , 1. k

03/15/2011 04:27 9105799096
GRICE CON
PAGE 01
A
North Carolina Department of En ion
rtiwifend NaWral Resources
Dlviston of Co Management
Beverly Eaves Perdue James H. Dee FreE
Governor r Secr
`NT 6UTH TI
Date: A & l Z-
Name of Property owner ApWng for Permit
KjM b.c�� 5, rZD6 6..• s
Owner's UsIHng Address.
1 9L.01 M lap ICCro-ff CV %e IlaA
G 2.10 31
of
for this project:
Phone Number (71 q? _O Phone Number
I certify that I have authorized Nia agent listed above to ct on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to Instal or construct the following (activity)'
(my property located) at _ L-6—t �,y
This'certificaborl is valid thna (date) • 3a t3
Prop* y owner Signature
4 {la
Q
f. U.• 1 --
Date

US MAIL
CERTIFIED MAIL - RETURN RECEIPT REOfi1ESTE'D
DIVISION OF COASTAL ibMANAG'EMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT.
Name of Property Owner:
1.3
Address of Property: }
Q (Lot or Street ##, Street or Road, CityG& County)
Applicant's phone C�" %) q S Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pei
has described to me as shown on the attached drawing the development they are proposing. A description of draw
with dimensions, must be provided with this letter.
Ol 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 (DQ
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive J
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the.same as no ob'ection if you have beert notified by Certified Mail.
WAIVER SECTION -
I understand that a.pier, dock, mooring pilings, breakwater,. boathouse,. or lift must be set back a minimum distant
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 IS' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owne I formation)
t ��
Signature
�a„�\� ���c.� �Qy���
Print or Type Name
Mailing Address
(Riparian Property Owner Information)
Sign
Print or Type Name
Mailing Address

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REPTESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT .
Name of Property Owner:
Address of Property: \—tJ ` 3 I 2�
(Lot or Street #, Street or Road, CityG& County)
Applicant's phone #: 1V-� S] C�" cm q S Mailing Address:
LC 0
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pet
has described to me as shown on the attached drawing the development they are proposing. A description of draw
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 (DO
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive l
Wilmington, NC 28405-3845. ACM representatives can also be contacted at [phone]. 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 distanc
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 I5' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owne I formation)
�Signature
Print or Type Name
�aw—Q_ � L
Mailing Address
(Riparian Proper�ty,:Owne ) Information)
Signature
jZ,)R&& 1 —SJ�A.) L L `Z
Print or Type Name
Mailing Address
F11y E %%L lLl, L_L -t ,

a4'
\�'
C�Cs���s�� t3-each

Applicant:
Date:
lb3
Permit #: `f' j L; O Z (1
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
labitat Name
DISTURB TYPE
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/or
temp impact
amount)
WDredge
❑ Fill ❑ Both ❑ OtherX
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 ❑
-?4 x `-i-
= q Ce

•
�.j
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lc u ����� ?J-J�ucn NC
z ^'i
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2. Article Number (t7009 1,680 0000 2205 9687
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Box N �. 57�.. `.. �.....
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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
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`l 2-1319
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