62573D - Shipton

a'1 M K
_CAMA / DREDGE & FILL
E N E RAL PERMIT Previous permit #
New Modification - Complete Reissue ClPartial Reissue Date previous permit issued_t
rized bY P the State of North Carolina De artment of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursu
nt Name V
t - State We -'LIP 7i�yt'`
0) 5 Fax # ( )_
zed Agent
d r; CW ,� �W L, PTA ❑ ES PTS
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / no., PNA es no Crit.Hab. yes
A Project/ Activity Z/V►- k I I
lock) length
pier(s)
length
umber
gad/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards
amp
use/ Boatlift
B zinger-
004 CA
ne Length +>/-" &
not sure yes
Lgs: not sure yes
)rium: n/a yes
yes
Attached: yes
ant to I SA NCACy r 1 i-;— C'C'I
❑ Ru/l�s attached.
Project Location: County � � L-�.-C74—
Street Address/ State Road/ Lot #(s)
/ i 7.
U " P16 ✓ C b cJ t� OGi
Subdivision
City ZIP
Phone # ( ► 6)( U13r River Basin
Adj. Wtr. Body l / l SGl 1 %
Closest Maj. Wtr. Body ! �� �-�'�
(Scale:
ling permit may be required by: V 4— lit (��..0 ❑ See note on back regarding River Basin

plicant: vt Permit #: (Q z 15;3
te: L v(
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
iitat Name DISTURB TYPE Disturbance total
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 ❑ 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 ❑
=jVjr-- • •9.
--
• • M
c
N
F=-

WESTERN UNION FINANCIAL SERVICES ewDoINC.d ISSUER
N.A.. Grand Junction, Colorado,--
Bank Grand Junctio
14-758142213
.1149 D 100113 f
21422133 L 00018
ARS AND No CENTS p . OR/ACCT. #
'S ADDRESS easslceATuae
It,758b422133"'

jAVISIMI ClCOASTAL ►diANAGSMER
ADJACEff WARM PROPERTY OWNER N0TIFiCt- TI0i4ffvAN,'SR FORM
Name of Property O
wnerddress of Pro?arty;
(Lot or Stmett, Sheet or Road, City & CourIM
Agent's Name ik -- �� �- ` c-
Agent's phone 4: .1
L-Aing Addresel---
1 hereby cortkfy V,at l propert., adjacent to the above reforemy-J property. ` hci indivi�ual
applying for thi rMrk IS dewdtl : t(; me a€ shown on the attached dwvfti e development
they !7,Fp*sq. Ads-- -or ^ raja. title dkn;3`sions. )� kwid _ hisettrr.
T have no objections to this propose'. T have objecl;ions to this proposal.
if you Fay a 0ttjoct70ns to t!hc t tz �31n pt x ta€ 6d, ,you mus€ nc G{y �i8 QfvlsfOf; Qt� " �:t WADVeMent (G't~f� j In
Wfft z3wn i© days Of revo.'-t et tills 46Uf _. corrsspondoneo should bs Maned CO 1?7 Cerdlnel Drive lL,
tlErNrrtht : l+lC, 284e5 M. DGM t W3nm- d s can Wsa he cantaaiil 9i (tie) sus -_me No rospertso 1s
n-;sve r.Don rFGi?F ------
J.""A t'Ek SEC110M
I understand that a pier, dock, moonngi Pilings, breakii Oer, boathou. e, lift, or grain must be at -I
back: a minimum ev'istance of I %' fro-M rn aria of riparian ac om uniass waind by me. (if you
Msh to weive the setback, you u _ — - t"ie appropriate blank below,)
G -- �Jv_�
Eft Wigl i tO W&E thS I
(Prop-.Bw. Men 6r Itdormu fon)
Signature
v _
Print or Type Nam
Nfafiing Address
c lw a -
(r.dja� ropeEur{ oj,.-jcr Information)
-signature
G 9h
Print or Tvoa Name
± LJ L_ L ' TAtgnhnm Numhor

ERIIl°M K(AI�URN RECEIPT RE99E$
UIVISIGN OF COASTAL 1AANAGUSUT
ADJACENT RIPARIAN PROPERTY OWNER NOTIiFICATIONIWAIVER FORM
Nerne of Property Owner:
Address of Property; . - ze-7 t°i �a�e G�,
(Lot or Street #, Street or Road, City & County) `
Agent's Name #: i.. � C4 .. / C� Wailing Address:
Agent's phone; 9 //�
/11
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 drawi%Lft development
they are props mg. A description cr drawino with dimensions gust ba 2Intded v�it is letter.
T have na ok�jectians th this proposal, 1' have objections to this proposal.
If you .have objoctl ons to Whet lr baing proWod, you must nc ttfy the Division of CoaMI Management (DO) In
wddv wiMin 10 days of recalpt of this nod= Conwpondranco should be matted to 127 Cardinel Drive &L,
4t *dngtan■ NC, 28405.3849. DCN mpnmengadves can also be contacted at (910) 79& 7215. No response is
consldarod the same as noLwtbn if you hsb vo boon notlRe d z Certified Nall,
i ramie■ i 1ri■��G■i � �
VVAIVER SECTION
I understand that a pier, dock, mooring pilings, breakmater, boathouse, lift, or groin must be set rk
back a minimum distance of S 5' from my area of riparian vi=ss unless waived by me, (if you
wish to waive the setback, you ff,uEt aj the appropriate blank below.)
do wish to waive the 15' setback requirement,
/- I do not wish to waive the IS' sethack requirement.
(FsroportV Owner Information)
Y
G
F'rint 6r TyperNamb
N A--�6"42 -,&
Mailing address
Aa&-,,45 �,,sj 2g �-y V ?
6 P�-e-
Mailing address
A/V ) �,W(3
KtatdOp `
'l "Istatbaip
L/�7 ?k/S�