76569D - Noble

LAMA / ❑ DREDGE & FILL N9 76569 A B
IENERAL PERMIT Previous permit#
.New :]Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
of
ized by the State of North Carolina, Department of Environmental Quality r
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC (F-1 Rules attached.
Name �r rT L)�.►`P� Project Location: County ,J✓ter c w c k--
Z uO Pal \ u Street Address/ State Road/ Lot #(s)
Stated ZIP Z�(vl ����S
(t ) SS I �056 E-Mail , 40 Subdivision
` arcach ZIP Z `t
ed Agent LQ �..y- LI& City � J n S e
K.CW K EW )U PTA RgES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UIRA ❑ N/A
❑ PWS:
yes O PNA yes
Phone # ( ) River Basin Cu,., �
Adj. Wtr. Body C��^ (n<
Closest Maj. Wtr. Body V Ce% r (7, \
' Project/ Activity V-QVXAh 0Q 1kane- d . JT -J C , - CX J\e" C\ua
-\�c���� T (Scale:)Y
ck) length I ' 101, ' CJ
atform(s)
Platform(s) HN lu—
ogth
tuber
d/ Riprap length_
g distance offshore_
ax distance offshore
hannel
ibic yards
mp �►
us oeYB atliit, >V %� I
3ulldozing
ne Length " `) O
not sure yes
)rium: n/a yes n (�
yes n
Attached: es no
ling permit may be required by:
1 . 1 PI—nina hiricrlirtinnl
❑ See note on back regarding River Basin

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner- Requesting Permit:
Mailing Address: cI 2ao V e.-1rr• T3�•� CZ, r ��
Phone Number: �� So --
Email Address:
d bnAk e 4 0 a nXQ-.j 1.
I certify that I have authorized 6"te RS��L�tJr� ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at Aw
in J `Lktk5 W �L- County.
1 furthermore certify that I am a�iorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the LocatPermit Officer, and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
PropertX Owner Information:
Si nature) - /-
7 ���J, E1_
Print or Type Name. _
Title

CERTIFIED MAID - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION1WAIVER FORM
Name of Property Owner. _ �y b `� t)U P,- __ __
Address of Property:
(Lot or Street #, Str et or Road, City & County)
Agent's Name #:G r kct'.. F*LlJlk�o
Agent's phone #: %o- Ci u9,5
Mailing Address:C(1 t 3QCAC\1A Dc- 3W
&�- ) -ale �46A N( 2, y%q
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 descrri tion or -drawing, with dimensions MUst 1-OMAded witthis matter.
A)e4 1 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. CorrespondOnce should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representativos dan also be
contacted at [phone], No response is considered the same as no objection Hypo 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 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si mufure
Nuuk
Print or Type Name
� Cl rC.1
Mailing Address
CitylState ip
a
(Adjacent Property Owner Infon*W! n)
.Si,�nuhu•e
Print or Type Name
Mailing Address
CitylStatelZip
rn. —

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. 1 0 b N OU e
Address; of Property:
h3v
(Lot or Street *rN , Street or Road, City & Co//un��y))¢�
Agent's Name t, t� 't`►Ct �UC�{`tl j�o Malting Address:cD It 1�ch
Agent's phone omkn l�[Q u, (\
certify that I own proery itdjacent to the above referenced property. The Individual applying for
it has described to me as shown on the attached grawing the development they are proposing.
I have objections to this proposal.
N you have okhcdons to what Is being proposed, you must notity the D!Ivr of Coastal
A1*nd90M nt (OCU) In wdit within 10 days of receipt of dils notice. Correa should be
ffm~ to 127 Cw~ Drive Ext., VMmkgton, NC, 28405.3845. DCM ropy" also be
contacted at ('810) 7W7215. No response Is considered the same as no objection 0JAWAilpoften
nod fed by Certifteat Nag.
WAIVER SECTION
i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back s
mi tance of 15' from my area of riparian access unless waived by me. (If you wish to waive the
the appropriate blank below.)
I do not wish to waive the 15' setback requirement.
{Property Owner Information) n T�
Sture
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NoW
Print or Type Name
q2w !pa\yn R�4, GrL\
McHing Address
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City've +p —
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Telephone Number
Signature
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■ Complete items 1, 2, and 3.
■ 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:
"yam
2.71 SV I�1Z3�
9590 9402 2219 6193 1040 73
2. Article Number (Transfer from service label)
7017 0660 0000 7487
PS Form 3811, July 2015 PSN 7530-02-000-9053
A. Signature
x 4% COU tq
B. Rec ved by (Prince Name) C. I
Wi:"i �to*so y
D. Is delivery address different from item 1?
If YES, enter delivery address below:
3. Service Type
❑ Priorit,
❑ Adult Signature
❑ Regist
❑ Adult Signature Restricted Delivery
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Domestic
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CERTIFIED 0 . •
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