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❑ CAMA / DREDGE & FILLv
�ENERAL PERMIT
Previous permit #
New ❑ Modification ❑Complete Reissue ❑ Partial Reissue
Date previous permit issued
Drized by the State of North Carolina, Department of Environment and
Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCACyc
/ ''
nt Name f �'►
El Rules a}�hed.
Project Location: County 11 A Z,
11�1
s �3 4 �� �T b
Street Address/ State Road/ Lot #(s
�
1 �SAlf"!�` � State�K ZIP 2�) � % '
0 Fax # ( )_
Subdivision
zed agent hs
City ;(4 `�� { SP�I ZIP
❑ CW JpEW PTA ❑ ES PTS
0 OEA I7 HHF ❑ IH ❑ UBA C N/A
Phone # River Basin 4--
`K�►7/ S C �h/
Adj. Wtr. Body na
❑ PW_5: ❑ FC:
yes / n� PNA yes / o Crit.Hab. yes / no
Closest Maj. Wtr. Burly
A Project/ Activity
ock) length
length
umber
ad/ Riprap length _
vg distance offshore
iax distance offshore
:hannel
ubic yards
imp
/JI
)Use/+(pi *--; XI7
Bulldozing
'/4 f61 ,,
►f
(Scale:
ne Length
not sure yes
gs: not sure yes y
>rium: n/a yes n
1— -
yes
Pt -T -l- -
Attached: yet no -
ling permit may be required by: r L'✓►'f Q V✓✓I,�5 (✓1 I�! , 444]See note on back regarding River Basin
pplicant: / Lo (e L7 �/ h ���11 lip
ate:
Permit #:
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat 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/orternp
impact
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)
�v v
Dredge ❑ Fill ❑ Both ❑ Other OK
/taamount)
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 ❑
LINE CONTRACTORS INC
PO BOX 868
;VILLE BEACH, NC 28480-0868
Z'
? 3111 1:0 S L.0000 301
3173
DATEII
ip
$ �d �-"
532L8i46
OLLARS
15-3/540
B93
AM-14-2010 ®8:52 From: To:91025630b2 P.? 1
&A
kl^rth Carolina Department of Irttvlrpntftent and Natural Aeaourms
of Conti$ Manscement
9w
UVI r
SolL ` /,fie
P,0. Box8M
(910) 256-3W
Des Fmw2n
wrei F9
ti ✓y �/ � �s1b� �jui�iL�l7 ►�- Name Autha ed A440t for INS ptoleot
N c,'xisriir 76,0 G g3 Cd
l�w;Tb 4
V
phone Number
Agent's MatyngAdMMS:
Phone Number
that I have authorized the agent ttsted above to tot on my behadrfoeor the Purpose(Ocjjat aPpk�n4
i °1iY o IdtT� t ln/�a�taNor conatruo► ,
for With otnaintnA att C - Per�m� !_l%kiluc i 6i
(my ¢ropaM IwAted) of
ihfattltlrtlon id vaVid thru (date)
D&O
Proo*rty pyrfor $Ipnature
RECEIVED
DCM WILMINGTON, NC
JUN 2 1 2u113
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n v)'1szv'D
3
RECEIVED
DCM WILMIN aTON, NC
JUN 2 1 2013
�/"1tl1J 1T..�� �1OL70064�
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til
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�nadjProp 010
OMSION OF COASTAL MAWOMEN
ADJACENT R#pARpRQPEM OWNER NOTWKA- TiON &WAIVER FORM
'l
Name of I"dMduaf appfying ftw Pam*
ldim at
i hweby COMFY that I awn property add to the ebm MWMlt=d pfotfe". The
indiwi" g;0 for tfds penntx hee dwaind to an n show an the
dfuwtng the pmeot fty eve p ft. A dexriptlm or drmMi vAM
dl� should y►Quld be pf whh Oft btbw Of i
pkme d beww if YOU Neva RO QAje ivna.
I have no ab*60" to Oft p �
if ym have obodorw to what iM bWV ArbP15 1' • Pkww write ate t4Mion of Coop"
mumemmty 127 C6010 Mw eiftrokw% VWminqtoni N. C. 2B406 oroa 910~
n14" at
WAniER SN
I wtdarotpad that a piari do* moo" pong1k Weakwowbod WACO or
sandbW moat bold back a mWnwM of iF fmm nrl area of rtptWn
trde" wwv d by Awdff you vfth b **w the sue, rau M* fil" ft � C E I V E
ft* b* w.)
'- I M WILMINGTC
I D4 w$h tD wad Dte 1& aelba* rags J U N 2 1 201
I DO NOT whh to valve the IF mbb* ImIrpi emeed.
S�
a4L
a! prfiett tie
�r k&trA%."sat irw Cede
& m"
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit Z(--l°'v W �512�ft
�I,u
Address of property 23 bl*ob /� �., ✓� ��
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 should be provided with this letter of notification.
Please initial below if you have no objections- ' i
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 910-
ithin 10 days of receipt of this notice. 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,boat house,lift or
sandbags must be set back a minimum 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.
��j%� Signature & Date