62553D - Wilson

CAMA / ❑ DREDGE & FILL V
iENERAL PERMIT
New a Modification ❑ Complete Reissue ❑ Partial Reissue
Previous permit #
Date previous permit issued
zed 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 > ! LV
ules attached.
N {fie A L-F�� Wj L So i-J Project Location: County 'k
y�1 0 r Street Address/ State Road/ Lot #(s)
t L State NL" ZIP Li 4" F vt t t f i
3CFax # ( ) Subdivision
;d Agent I.0 L' (Y\i l -- fZ ��1 `-� i City
ZIP C7'W 11
❑ CW EAW EWTA ❑ ES ❑ PTS Phone # ( ) River Basin (—1 rT E
❑ OEA ❑ HHF C IH ❑ UBA ❑ N/A Adj. Wtr. Body A`I W LA)
at n
❑ PWS: ❑ FC:� J
tes / no PNA no Crit.Hab. yes / no Closest Maj. Wtr. Body
0
Project/ Activity
(Scale:
k) length l ► G Y `
er(s)
igth
nber
I/ Riprap length
distance offshore
K distance offshore
annel
,ic yards
ip
:e/ Boatlift
Adozing
e
Length iS
ig permit may be required by: UIt'V'. 1
n. . r r
LJ See note on back regarding River Basin rt
-- w—

lescribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
3und in your Habitat code sheet.
abitat Name
DISTURB TYPE
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 and/or
temp impact
amount)
0 V V
Dredge ❑ Fill ❑ Both ❑ Other
/l
�-
Dredge ❑ Fill ❑ Both ❑ Other La
� qO
:3 C)
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 ❑

:ONTRACTORS, LLC
367-2159
�ROLD CT.
AD, NC 28443
�1''/M
08-03
Bank of America
ACH R/T 053000196
6006
66-19/530 NC
58754
DOLLARS e
AUT IZED SIGNATURE
__, _hP

i
Ia71p, 0-7\
n

CERTIFIED MAIL . RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: '
(Lot or §treet #, Street�or{Road, City & County) d
Agent's Name #. h/ I b cd �Ar1/?L �U`�11Aailing Address: � A�y(/T.
Agent's phone #:3U ,�%rn✓IS� ��,�
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.
C I have no objections to this proposal. I have objections to this proposal.
4u have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing wifhin 10 days of receipt of this notice. Contact information for DCM offices is
available at 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, lift, or groin 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.)
--K C I do wish to waive the 16 setback requirement. 1u Sa v4- +^Ax- on 6A—
I do not wish to waive the IS setback requirement.
(Property Owner Information)
Sig;tat'%re
Print or Type Name
(Adjacent Property Owner Information)
41
7arure
Print or Type Name
iadinn Af"racc
g1,01 E. NIL, 131",uL UQ--
Mailino Address

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date V21
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) 411-W29216c, to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Yj &k r
at (my property located at) +j 0o FQf Ya 4 4-
This certification is valid thru (date) o
Property Owner Signature
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner.
Address of Property: Tm i% za6w yr vw^- ..r»urw v11444%
I / (Lot or Street #, Street or Road, City & County) I Il
Agent's Name #: >�'/ l' / '�Q�InI� d S �Mailing Address: qc) /8 Hllfz
Agent's phone #: 9'/41 ' ro?3Q W- � 3
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 pr posing. A description or drawing with dimensions must be provided with this letter.
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 1 o days of receipt of this notice. Contact information for DCM offices is
available at 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, lift, or groin 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 16 setback requirement.
I do not wish to waive the IS setback requirement.
(Pro rty Owner Information) (Adjacent Property Owner Information)
7F
Signature Signature I rr
k&eil a (r9 •-f '( -WGl lfr' ,4- �fiblr+i r►
Print or Type Name Print or Type Name
%WYJ t ! I � eAoo4 4M 6121)
A..,.,.,...., Mnilinn Arkfrpst

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