59130D - Dixon

CAMA / DREDGE & FILL
'ENERAL PERMIT Previous permit #
,New . .Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of 11orth Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
it Name ti OV V(a it Project Location: County -�1�1JV1Slnll Lk
.Ila
d V1 COIL Pot. Street Address/ jState Road/ Lot #(s)
L��& 6ft State_& ZIP�nt �� � K,{"A1 Ny✓ LV4
Fax # ( ) Subdiyji�sion I ah l� Pad(
.
:ed Agent (�_.� L��� �yYU t, � City 1/ U (J I�' ^ ] ( ZIP I , ,
❑ CW �2 EW ❑ PTA ❑ ES ❑ PTS ne # �� ) lY LO �q }_ River Basin W M
❑OEA ❑HHF IH _UBA El N/A
❑ PWS: ❑F
yes (no) PNA yes / no Crit.Hab. yes (o
'1
f Project/ Activity
J
)ck) length
n(s)
)ier(s)
tngth
tuber
d/ Riprap length
g distance offshore
ax distance offshore
hannel
Adj. Wtr. Body V V\ U I+, (nat I
Closest Maj. Wtr. Body Al w W
(Scale:
/i
required by:
U See note on back regarding River Basin r
A _1 . , i i l_ I .. f I

13. Lu1L id: ud #15d4 Y.uu1
p.l
A4,;
North Carolina Department of EAVironment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Uses H. Gregson Dee Freeman
oi+ector �mta' Y
Governor
AGENT AUTHORIZATION FORM
Date. d/Z
Jame of Property Owner Applying for Permit Name of Authorized Agent for this project.
i2)CAA09 D/ X O
owner's MaYIng Address,
Phone Number
Agent's Maifing Address'
_/ 7 $O .�/UW
Phone Number
I certify that t 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).
WOW
N�
(my property located) at � � ������� CT• �6'Ff+�� xS� �" ��AC �
This certificaticn is valid thru (date) y��C� x
l' 10 0/.2
=Oer;y Owner Signaturd Date

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
fame of PropertyOwnerLLSS�LC/YDA/
Lddress of Property: e0ltgr-
(Lot or Street #, Street or Road, City & County)
,15
Lpplicant's phone #: 0 -76,6-60,55 Mailing Address: /790 PAW W04D 7A14
►9tWr- 9lo- &za- ell?7 Alz8
hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
,as described to me as shown on the attached drawing the development they are proposing. A description of drawing.
vith dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
f you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
n writing within 10 days 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
onsidered the -same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater,.boathouse, or lift must be set back a minimum distance of
5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
ppropriate blank below.)
Ty1w— I do wish to waive the 15' set back requirement.
I do not wish to waive the IS' set back requirement.
Property Owner Information) ( rian %t'
�ner Information)
V
>ignature Signature
?riot or Type Name
N/7&,2 YA-7L 0 b- f'r oA-
Print or Type Name
3to 901t/N✓-Az1 cook
Mailing Address
Mailing Address

s
'1 \
pgg IL
E,��ST�Nq pvtli 15
RilwOr 20 wi ��

^�K�p'�g1"VTtl7�Q �p VM!l
(PP woA WANA) tj S q
�rdwA uoX�d .
W- ,

flicant: �� U . yam Permit #:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
DISTURB TYPE
itat Name Choose One
Dredge ❑ Fill ❑ Both ❑ Other
omplete items 1, 2, and 3. Also complete
;m 4 if Restricted Delivery is desired.
rint your name and address on the reverse
that we can return the card to you.
ttach this card to the back of the mailpiece,
on the front if space permits.
-ticle Addressed to:
D. ,QoX Z 80
/yf y�rt�c- L -Nell SC
z 9s-97
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
and/or temp
tpmn imnarf-0
impact amount)
Z'
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
Disturbance
disturbance.
total includes
Excludes any
any anticipated
restoration and/or
restoration or
temp impact
A. Signature
❑ Agent
X ❑ Addressee
B. Receiv / by (PrfName) C. Date of Delivery
e� 1�n5 �2-14-12-
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered EW"Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
rticle Number
Transfer from service label) 7 010 3090 0001 1219 7773
=orm 3811, February 2004 Domestic Return Receipt
102595-02-M-1540
Dredge ❑
Fill ❑
Both
Dredge ❑
Fill ❑
Both ■ Complete items 1, 2, and 3. Also complete
item 4 if iestricted Delivery is desired.
■ Print yo, name and address on the reverse
Dredge ❑
Fill ❑
Both i so that w , can return the card to you.
■ Attach th card to the back of the mailpiece,
or on the 'ont if space permits.
Dredge ❑
Fill ❑
Both I
1. Article Ad vessed to:
'S <Z
A. Signa re
XUVAk
B. Received by ( Printed Name) C. DE
D. Is delivery address different from item 1?
If YES, enter delivery address below: