62510D - Werner

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CA' A / DREDGE & FILL �v 62
ENERAL PERMIT Previous permit#
New ❑Modification - Complete Reissue ]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 NCACr1 r'
❑ Rules attached.
t Name } V j� �'i Project Location: County i(i osltj (c I—
{" Street Address/ State Road/ L (s)
vk)IState- ZIP_1-4L r 1
i
(_ 1 Fax # ( ) Subdivision
r ty Lt., ZIP
zed Agent Ci
d ` CW EW APTA I ❑ ES EIPTS Phone # River Basin
C OEA /� HHF El ElUBA ❑ N/A Adj. Wtr. Body) \ nat
P)VS: ❑ FC: n
yes / no PNA yes / no Crit.Hab. yes no Closest Maj. Wtr. Body �! l I
W►_•:tiXINVW==112�1146
gad/ Riprap length_
vg distance offshore
iax distance offshore
channel
ubic yards
imp
)use/ Boatlift
Bulldozing
p
ne Length
(Scale: I
not sure yes no
:gs: not sure yes no
)rium: n/a yes ;:-"A¢
yesno
Attached: yes no
ling permit may be requires
-- " 1_.11 OM A , . A . I I r..1 t .. , ► -, . i c L. I

)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
abitat Name DISTURB TYPE Disturbance total
disturbance.
Disturbance
disturbance.
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
IDredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
D
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
Of ■ 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,
Or or on the front if space permits.
1. Article Addressed to -
Or r(es �� �►�ke'vhe(�
Or 47rAV ; se4es T
Or C A i
Or
A. Signatu e
X❑ Agent
❑ Addressee
B. eived by (Print e) C. Date of Delivery
i
D. Is delivery address different from item 1 ? ❑Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail
❑ Registered
❑ Insured Mail
O Express Mail
❑ Return Receipt for Merchandise
❑ C.O.D.
Or 14. Hestricted Delivery? (Extra Fee) E3 Yes
— 2. Article Number
(Transfer from service labe, 7 010 3090 0003 715 7 7 0 3 3
Dr PS Form 3811, February �— Domestic Return Receipt
102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
L ( 1 1 _—) -- I ,

■ 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,
or on the front if space permits.
1. Article Addressed to:
Vol U,'rIa 0'--X
A. Signet fe
X n ❑Agent
❑ Addressee
B. R 'ved by (Pri Jed Name) C. Date of Delivery
l C
D. Is delivery address different fro It n-#? ❑ Yes
If YES, enter delivery add r bqLQw:._ ❑ No
3. Service Type
❑ Certified Mail El Express Mail _
❑ Registered ❑ Return Receipt for Merchan6ise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number (Transfer from s 7010 3090. 0003 7157 7026
PS Form 3811. February 2004 Domestic Return Receip
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fat
r
102595-02-M-1540

h` cd iika-"L 1-
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
lame of Property Owner: Pav I J Oec�(-
V,Address of Property: �-6ZS 1 dJI at 0 � A soy VJ � �I - �� Vic ay\5 W I C k G.
p h (Lot or Street #, Street or Road, City &j�Ciounty)�-
kpplicant's phone #: �'� % _ I I l I Mailing Address: �I V0
- I') P,�,I?III
hereby certify that I own property adjacent to the above referenced property. The individual applying for this pen
ias described to me as shown on the attached drawing the development they are proposing. A description of drawi
with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
[f you have objections to what is being proposed, you must notify the Division of Coastal Management (DCb
�n writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive E
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
-onsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
[ understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)parian Prwnfr Information)
Signature
Day ta Were
Print or Type Name
121-1 K 6 rfk 19 +� s ,
Jau . H Or-1 'qhJ U
Print orType Name
qv► -Pr-e-5�� V;I�
Mailing Address
Mailing Address

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3everly Eaves Perdue James H. Gregson Dee Free
governor Director SecrE
AGENT AUTHORIZATION FORM
Date:
ame of Property Owner Applying for Permit:
DV I A 02r`her-
owner's Mailing Address:
imp ►11, .�, IWO
hone Number (I il)l (01' M I
Name of Authorized Agent for this project:
yarn oye�-
Agent's Mailing Address:
0, Box 1373
5► qI1 a 1 &1 -)-R
Phone Number(910 )yy3_g52,L
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
x and obtainingall CAM�IA Permit necessary to install or construct the following (activity).
P�&C- CtAA Tioct,��r�a ( ock e;fC,
my property located) at
'his certification is valid thru (date)
0....... 4— iluinnr Cinnn4,vra
o1g_N�-
1 /10 , 4o I
Date