57584D - Davenport

SCAMP- / DREDGE & FILL V
GENEI.. PERMIT Previous permit #
JNevv, odification ❑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 NCAC 7` ' • /1
❑ Rules attached.
it Named , { z^ 1� Project Location: County
Street Address/ State Road/ Lot #(s)
State L ZIP ( 1 't , J i '-Jr) VV - ' 1-j�Ih P Di .
Fax # ( }
zed Agent ' ` —
i CW EW PTA
OEA HHF IH
PWS: FC:
yes / no PNA yes / no
ES PTS
UBA ❑ N/A
Crit.Hab. yes / no
Subdivision
City L/:K- 1 SLR ZIP l
Phone # ( ) River Basin L"Jt
Adj. Wtr. Body i'- JAsme N C `,t W kl- dtg/
Closest Maj. Wtr. Body A Sul �y
f Project/ Activity ;..L I►_; it `"'i I L tIL'., Z `�• ` L` 'i i .r
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imber
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Riprap length
g distance offshore
ax distance offshore-
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ing permit mayte'required by:� ❑ See note on back regarding River Basin r
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property
(Lot or Street #, Street or Road, City & County)
Applicant phone #:/_ ?f S 'r7`/ Mailing Address:fQ—�
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.
4�1_ 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.nccoastalmangement.neticontact—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.)
4_� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
�LL�" 14 e- '
Signature
Print or Type Name
Mailing Address
(Ripar' Property 0?,vjner Information)
re
44mfT 'g 77v/_
Print oPtype Name
J�7� S' +r✓,Vi I j _7Jem, a
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road,'City & County)
Applicant phone #:'?��-" 77-5--" '9'714'�"l Mailing Address:
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.nccoastaimangement.neticontact-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 I
� � C
'Print or Type Name
Mailing Address
(Riparian Property Owner Information)
�� ��y✓-� �':��:�-cry_
Signature / i /j
C? ctitir / a (t.
Print or Type Name
S i z e G✓. &IAA,,. 'br
Mailing Address

NIFAA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Fre
jovernor Director Sec
AGENT AUTHORIZATION FORM
Date:Z--
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
A".11f" 5ya,_ &
1wner's Mailing Address:
7/a
'hone Number (g/�
Agent's Mailing Address:
2 4 �6 t✓ o ���A ��
[AsYc-l2©
Phone Number (910 ) 7l ,? FQ S/
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located) at
"his certification is valid thru (date)
10
26K,6
Property Owner Sign ure Dad

/20/2012 21:51 7762930 DAVENPORT PAGE 021
UIVISIO OE COAS I MANACEmEza
AD I &ENT RIPA, t� AN PROPERTY OWNER NOTIFICATION/WAZMR EOR.
:dame of Individual Applying For Permit:_RLQkaeL L
Address of Property: __ - 11� Q W. �J
{Lot or Street ##, Street or
(City and County)
I hereby Certify that I own property adjacent to the above -referenced property. The individual
applying forthis permithas describedto me as shown on the attached drawing the development they
are proposing. A description or drawing, with dimensions, should be provided with this letter.
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, NC 28405 or call 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no obaection if
you have been notified by Certified Mail.
AIVER, SE
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
set bck a minimum distance of 15' from my area of riparian access - unless waived by me. 0
you wish to waive the setback, you must initial the appropriate blank below,}
I do wish to waive the 15' setback requirement.
1�_ I do not wish to waive the 15' setback requirement
Print Name

plicanti � ?oP-r
Permit #: S 7SS
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
ind 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/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fin
disturbance.
Excludes any
restoration and
temp impact
amount)
yy
V
Dredge ❑ Fill ❑ Both ❑ Other o"',
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 ❑

'/26/2012 20,24 7762930 DAVENPORT PAGE 04,

7/26/2012 20:24 7762930 UAkENPORT PAGE .Y
■ : - E
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PRO
pERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot ar Street �. Street or fto®ci, City &County)
Agent's Name #: Mailing Address:
Agent's phone #
scent to the above referenceprop
erty- erty. The individual
I hereby mil/ that I own property adjacent the development
applying for this permit has described to me as shown on the attached drswlntJ-
they are pro ng.
1 have no objections to t)tis pnpposal. l have objections to this prQposai.
If you haw objecgons to who Is bslrny proposed, You must n00Y M9 Dhrlsia» of Coasfri Mom_ ►►t
a") in wrWng within 10 days of roasrpt of this notice. Contact I� OAS]' No
avoliable at or by
�.,..—& re t• atafd ud dM same ss no ob)ecdon ff YOU have bow rwtlA'sd bV CsrW*d AWL
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater. boathouse, lift, or grain must be set
bw* a minimum distance of 16 from my area of riparian access unless waived by me. Of YOU
wish to waive the setback, you 111<1 the appropriate blank below.)
I do wish to waive the 15 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property CWA Informal
{an)
J+
igr► tune
PnntOFTyPS Name
(Adjacent Property
r ��D§ �Roc
Print or Type Name
jwt om
MaN1ng add+ass /� j

26/2012 20:24 7762930 DAVENPORT PAGE
CE IF E IL • R C 1 U 8T
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONrWAIVER FORM
Name of property Owner:
ii
Address of Property*• (Lot or Street. Street or Road, Ci &County)
Agent's Name #:
Mailing Address:
Agent's phone #:
adjacent to the above referenced Property' The 'ndividuaf
I hereby certify that I own property 1 rawin9_the development
applying for this permit has described to me as shown on the attached d
they are proposing. A
wave no abjecctions to this proposal.
I have objections to this proposal.
ons to what is being Proposed, y'ou muo nodlythe of fat Me►►a�Wt
( you have obJecti of this nodes. Contact lnPorm OOR for DCA� offices is
(OM) in wrftJng whhM 10 days nicei�it svatlabM at or' by aeil/ng 1.688.RCOAST. No
�__.._�.. ,� ,...n:lrlwr.d !)re sarrp as rrv_o ecdon If et hares been notified kX Certdled ei
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum dismnce of 16 from my area of riparian access unless waived by me. (if you
wish to waive the setback, you Mt the appropriate blank below.) RECEIVED
DCM WILMI' .70N, NC
I do wish to waive the 15' setback requirement. JUL 2 7 2012
1 do not wish to waive the 15' setback requirement.
(P r Irtiontn on)
Ighature
Print or TYp$ Name
(Adjacent Properly Owner information)
Signature
Print or Type Namo