62575D - Sasser

CAIVIA / _'DREDGE & FILL V N? 6�
E N E RAL PERMIT Previous permit #
New -_ Modification ::]Complete Reissue C Partial Reissue Date previous permit issued
rized 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 (j —� ' ri
U U
❑ Iles attached.
t Name 4`l� �'`�%'! �'=-- Project Location: County S C lAJ
State_ A ZIP-3u
(Lq) Z'- +{Z c Fax # ( ))l
zed Agent f' MO , !� at h �Tr n t [�U✓�
d ❑ CW Q EW 4 PTA `L ES G PTS
C OEA �—, HHF IH UBA N/A
L— PWS: 71 FC:
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP ,f "f
Phone # ( ) ' �'` er Basin
A� Adj. Wtr. Body a w na
yes / no PNA ye$ / no Crit.Hab. yes / nro', Closest Mal. Wtr. Body✓✓� P Nji
)if Project/ Activity (� 5� L)
(Scale:
lock) length
- n(s)
pier(s)
length
umber
,ad/Jiiprap length f L.,
vg distance offshore
nax distance offshore '
channel
ubic yards_
amp
use/ Boatlift
Bulldozing
ine Length
not sure yes
igs: not sure yes
)rium: n/a yes
yes
Attached: yes
Jing permit may be required by: ) i/j S W ❑ See note on back regarding River Basin

olicant N
`e:
Permit#: 6
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
,id in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
itat Name Choose One 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)
(/ Dredge ❑ FffloDb Both ❑ Other ❑
ZD
Dredge ❑ Fill Both ElOther ❑
Z (?
10,
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 ❑

ISTRUCTION, INC.
INETT LANE
RRY, NC 28460
Bank of America. ��
ACH R/T 053000196 O
66-19-530
d
248411' 1:053000 L961: 2370 L5337748ii'
2484
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
tt� �
Date
Name of Property Owner Applying for Permit:
Mailing Address:
X d530 us flwx qo W.
X, Qld-sbe" 'NC, a7630
i certify that 1 have authorized (agent) / i r -� 0 ",`,r_1 CE-P�-tr L'C-h(S'? to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) ,_? �(�}'1. aid
at (my property located at)
This certification is valid thru (date) � () I f1
j( 7-J3,,,3
Property Owner Signature
-D,ae

CERTIFIED MAIL - RETvRN RECE,PT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFiCATION/WAIVER FORM
Name of Property Owner: 4--A`-} l I t I
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant phone #: J
Mailing Address:
i l � � +�`� �,� � _
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.
V 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.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if y_ou have been notled by Certified Maf1.
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.
(P perty Owner Information)
iC'Ib,vrni�ro
y DANNq SAssG2
Print or Type Name
a&M Us 70 u).
Mailing Address
(Riparian Property Owner Information)
Si"G'1 z re I y V
kiiin �IaPy
Pri�nit or Type Na e
�f�� 2GCGn L-A nQ
Mailing Address
I,- I r— Air Ilrzlii n

CEiiTI€IED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 1 Ti;' i 1t :lrit,t \) ;1 i� }" �Uiai(ing Address: _ h � W.
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 nhjec inns 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.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.
1 do not wish to waive the 15' setback requirement.
(P perty Owner Information)
AOWL
,ci,rv,ni, ,1.0
}{ ]>ANjU y Ss+sscsZ
Print or Type Nar?e
Mailing ,Address
G' 1116bW A G dISM
City,'Stete2ip
Y010qua-44a3
(Riparian Property Owner Information)
17.