62588D - Rourk

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3"E N E RAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue '—Partial Reissue Date previous permit issued
Ozed by the State of North Carolina, Department of Environment and Natural Resources jj �
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �'t . �-tJIJ
Rules attached.
it Name JL Project Location: County t6API&SAd (,k._
Street Address/ State Road/ Lot #(s)
Sl1A � atit ( � State ��2. ZIP Gm (A
C_ ) Fax#( )
ed Agent 7/A �rn C, &J iL.kU
Cw EW PTA ❑ ES ❑ PTS
OEA HHF ❑ IH ❑ UBA N/A
PWS: ❑ FC:
yes / no PNA yes /(no j Crit.Hab. yes //no
A Project/ Activity
lock) length V X4A 1 r)
z
Subdivision 1 "
City()elaiA' zlP'2�4
Phone # l t. ) Z 5 River Basin m
Adj. Wtr. Bod Cao i nat
Closest Maj. Wtr. Body A4 W Lk)
o.�
(Scale:
ling permit may be required fA • ❑ See note on back regarding River Basin
A (.J. _I

Applicant:
Date:
Af
0 4'7
Describe bel w the HVIATidistur'bances for the application.
'ound in your Habitat code sheet.
1
Permit #: �7snt
All values should match the name, and units of measurement
DISTURB TYPE
labitat 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 andloi
temp impact
amount)
I
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
a
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 ❑

. . .. ......... I . ................ - .............
MKS BULKHEADS INC
& UCK ESTATES
PLY, NC 28462
910-755-6861
6731
66-112/531
DATE
$ 4�OD
%
AND TRUST COMPANY
OT-COM BBT 8 -L45'S�43 0
cj 2 aj/2 III
3 1112 1:0 s 3 lo 112 11:000S 2 1 S J......... ..
--: ......... ..........
w

-2013 11:51P FROM:UARNAM'S DOCKS&BULKH 910-755-6871 TO:19103502004 PA
GL x 11-
V

-2013 11:51A FROM:UARNAM'S DOCKS&BULKH.910-755-6871 TO:19103502004 P.
F A X
Varnam's Docks & Bulkheads
1574 Monster Buck Estates
Supply, North Carolina 28462
Phone: [phone]
Fax: [phone]
000 _
V0o
non
:o .— 77
Comments:
To: !� 1AW-_ j Fax number: q 0.35D- 100
From: OAOM
Fax number:
Date: .20.13
Regarding:
Phone number for follow-up.
J",
,� Uwy +kL
of 07,�3

)-2013 11:51A FROM:UARNAM'S DOCKS&BULKH 910-755-6871 TO:19103502004 P.3
VI
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
el F. Emley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr., Sec
i Is hereby authorized to act on my beha.
(Printed Name of Agent)
;r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to t
c activities described in the attached sketch.
TION OF PROJECT:
V S Pell in su II
ERTY OWNER MAILING ADDRESS:
U Ip e /9S o c! 8_ re .S 4 LIll
►A/ re 4) M. 13 AWn?'S C. H /
97 AzriT,`ME Walt
31 , if c (°_ 2- g q-6 q
DRIZED AGENT MAILING ADDRESS:
M644}er BUCk L64e
Nlc agg a
PHONE NO. 9 L a 45 7-5'— TIP 7 S�
T
PHONE NO.

3-2013 11:51A FROM:UARNAM'S DOCKS&BULKH 910-755-6871 TO:19103502004 P.2
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property: I OT /j U �q '�--
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development t
are proposing. A description or drawing, with dimensions, should be provided with this letter
!/ I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 23405 or call 910-395-3S
within 10 days of receipt of this notice. No response is considered the same as no objectioi
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If y
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
a.0- Dj
I �o not wish to waive tha-13'-setback requirement.
Si n e Date