59146D - Borrell

Street Address//$tate Road/ Lo #(s)
Subdiv' ion (�r,
City G 1 ZIP .b f(
m River Basin w r r l
Adj. Wtr. Body Q A 1 nat
Closest Maj. Wtr. Body ' WW
(Scale:
CAMA / DREDGE & FILL
iENERAL PERMIT Previous permit #
New Modification El Complete Reissue El Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources -+ 4 1?-0-0
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
u" ` ulesattached.
it Name LU V're t Project Location: County &YISWICIt
INW1,W h State k ZIP M D 1
�TJ ! Fax # ( )
Agent
CW ;SEW �TA L ES - PTS
❑ OEA HHF ❑ IH ❑ UBA N/A
❑ PWS: ❑ FC:
yes / o PNA yes no Crit.Hab. yes
Project/ Activity 11��'YU'L� ►/1V
dock) length
pier(s)
length
-iumber
ead/ Riprap length
ivg distance offshore_
nax distance offshore
channel
:ubic yards_
amp
ouse/ Boatlift
ine Length
not sure yes
ags: not sur yes
orium: n- �yes
s: / Yes
r Attached: yes
ding permit may be r

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-MIT Wit
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue dames H. Gregson
Governor Director
AGENT AUTHORIZATION FORM
Date /
Dee Freeman
Secretary
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
S� �o �r e 11 rnus Cflu�i�ie ✓.��,
X Owner's Mailing Address: Agent's Mailing Address:
pal
ISM/
Phone Number ( ) Phone N.u_mber �il) 1 8 y- - 36 .Z-
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
---P "OiF ;i /G±/h0 tv"I acrrh 7C4 -0�
(my property located) at !M C-rau Pn S'1(-dFegH ZY-& [5&e'c:1 /?-t 2-4-"y6
This certification is valid thru (date)
Propert caner Signature Date
127 Cardnal Ddve Ext., VfMr ion, NC 28405 ND thCaro�na
Phase:910-M-7215%FAX:910-M-3964 hdeffWt W*W-naaasiainena9WI8At-nel An Ewidocv�riAlimOn Ad5wEmc'wal'ilf

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NnTIFIr-AT1nNnNe1VFR FnRM
Name of Property Owner: ZD /-/'e
Address of Property: Cfa t,�P h Sf t�,el �,1s le %� P�, /yC
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 3c�_ 3� �/' �Z�9 Mailing AddressY 3 S %
2-66 �L/- z 5--g6 0 � le s lVvh �c� / 0 7 J l
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.
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.nccoastalmangementnet/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)
Signature U
fcl.%orl'e//
Print or Type Name
Mailing Address
13c,j I r 5 �rv-- fa 1 oo i
(Ripar' o rty Owner Information)
Signatu>l
u « �3 , w0c O'd
Print or Type 14ame
56 3 ,'�e' 4, �+
Mailing Address

US MAIL
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATENIENT
Name of Property Owner:
Address of Property: Zf_ C'/�� G`� S ?—
(Lot or Street #, Street or Road, City & County) Ski f6G
^� Applicant's phone #: Mailin Address:
�5.3 .',' 4�7 � ��'� g
'D /W /
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 of drawl❑
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 Managemeut (DCM)
in writing witldn 10 hays of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the -same as no obiection if von 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 IS' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
SIgnature
f d ward ge",/e I
Print or Type Name
Mailing Address p
City / State / Zip
(Riparian Property Owner Information)
Signaturr`,� .
C"Y
Print or Type Name
Mailing Address
City / State / Zip
Telenhnne Numher 2 4' 3 " 3 G% i?- (2oll Telenhnne Numher

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Division of Coastal Mgt. Habitat impact Computer Sheet
licant: Permit #: 59114Lo C)
2- ILl
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I
,ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
tat 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
WDredge
❑ Fill ❑ Both ❑ Other
1
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 ❑