62657D - Speas

CAMA DREDGE
i i / N' 69
/ & FILL
3"ENERAL PERMIT
Previous permit# ' '"`---
New Modification Complete Reissue - Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and
Natural Resources
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Akf
t Name \-
❑ Rul attached.
Project Location: County kl ^vim
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Street Address/ State Road/ Lot #(s)
OC �
(' State C ZIP 'U'W O
Y
(y ) 7"-�,'7 Tom' Fax # ,( )
_'�?r,
Subdivision
ed Agent , ' ` � I C
_
City �) Y1-f;4,. S •• `V^ Y ZIP 7 t
CW EW -kPTA ❑ ES ❑ PTS
Phone # ( Basin k
❑ OEA ❑ HHF IH UBA N/A
''
Adj. Wtr. Body -� �i 1 nat
❑ PWS: ❑ FC:
yes / no PNA \yes / no Crit.Hab. yes /( no ;
Closest Maj. Wtr. Body ✓�"�
Df Project/ Activity f ^ A7 d Y-rn
lock) length
•m(s) 00 x Z D
pier(s)
length
camber
mcl/ Riprap length_
vg distance offshore
nax distance offshore
channel
L
ubic yards
_
—4_
amp
)use/ Boatlift
Bulldozing_
t
ine Length
/not sure
yes
no
f
igs: not sure
yes
no
-i
)rium: n/a
yes
no ,
,
.
yes
no
Attached:
yes
no
�. W co
ling permit may
be required
by:
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(Scale: f
a See note on back regarding River Basin

iplicant:S
ite:
1.
Permit#:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL 5q. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
{Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Iitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
I
restoration or
and/or temp
restoration or
temp impact
temo imoacts)
impact amount)
temo imoactsl
amount)
v Dredge ❑
Fill ❑
Both ❑
Ot r
7 W
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 ❑
■ 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 maiipiece,
or on the front if space permits.
1. Article Addressed to:
fMV t WS S*%V
A. Signature
X ❑ Agent
❑ Addressee
111 etved by ( Prime a ) C. Date of Delivery
r
D. Is delivery address di rent from it 1 T ❑ Yes
If YES, enter delivery address be] 11 No

Bank of America. _0, 2591
i�CONSTRUCTION, INC. ACN R/T 053000196
252 ENNETT LANE 66-19-530
4DS FERRY, NC 28460
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DOLLARS €
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00 259 Lil' 1:053000 L96l: 2370 L53377L,&n§

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date— a �I ad , J'V 13
Name of Property Owner Applying for Permit:
Mailing Address:
6/1 GJ'10�9-molc oR cle
SNeADS /1C 24V61)
I certify that I have authorized (agent) &-(10123 6)K+1 kc— to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) go ` q
Is
/D —9>— /3
Property Owner Signatu
Date

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner: P%CU t `I'
Address of Property
(Lot or Street #, Street or Road, City & County)
Applicant phone #: �)�_.3� -j_ 3`t S Mailing Address: Pwl71 nD►e-I ansi-eV CtI'DA
u
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.
r� 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 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)
Signatur
Rey R -
Print or Type Name
(Riparian Property
Print or Type Name
Information) _
Mailing Address 1
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Mailing Address

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