59180D - Gangi

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
-Aew Modification El Complete Reissue 'Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources jj ,,
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 4 f'1 �
Rules attached.
nt Name I A �l �. S all Project Location: County 71 fyy s w I LK..
State_ ZIP i; f ri- - S
#�W) 451 "39S5�t_ Fax
es#_( )
zed Agent �(F 11G�1�"�YVG�'1�
j -. CW EW 1_' PTA —ES PTS
OEA HHF _: IH - UBA ❑ N/A
PWS: L FC:
yes:/ no PNA yes / no Crit.Hab. yes f no
if Project/ Activity
Street Address/ State Road/ Lot #(s)
i .
Subdivision t,jf�
city o . 1 , � ZIP VI(
Phone # ( (C lY�t S'1-2'L River Basin UJ ry
Adj. Wtr. Body C"O.�%j (nat
Closest Maj. Wtr. Body A { 1A.1 LJ
v
Dck)length X
-n(s)
pier(s)
ength
ember
ad/ Riprap length
(g distance offshore
iax distance offshore
:hannel
ibic yards
mp
use/ Boadift X
3ull ozing
AMA )4(0
ie Length
not sure yes no
gs: not su yes no
1
rium: n/a yes
yes no
Attached: yes no
ling permit may be requires
(Scale: ( �/

0RECEIVED
MAY 042012
;M WILMINGTON, NC
lac
'�\h � .lhv�st_ � ��^� �•Ui'_'�a.ti-...�. c�,V ova �<-� � i�1cl-�.
��� � C'1 , � • � $ cam.\ �:. -"1 1p � 3

US MAIL
CEIVED -
CERTIFIED ANW 1, — RETUILN RECEIPT RE LLS ED
MAY 0 4 2012
DIVISION OF COASTAL ;!'MAINA.GEtMENT
ADJACENT RJPA.RIA,N PZ-.OPERTY OWNER STATEMENT
WiLMiNGTON, NC G-cw1Q
Name of Property Owner: �._ . �g 1
Address of Property: C-klYl'� er", 6
(� (Lot or Street it, Sur et or Road f City &
ity&: County)
`,�
Applicant's phone Mailing Mailing Address:
Q 2—`6 4
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 dzawin
wit„p dimensions, must be provided with this 1 er.
I have no objections to this proposal. 1 have objections to this proposal_
0
If you have objections to what is being proposed, you must notify the Division of Coastal Matiagement (DCK
is writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive U1.
Wilmington, INC 28405-3845. DCM representatives can also be contacted at (91.0) 796-7215, No response is
considered the same as no obLection if you have been notified by Certified flail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, brea!"ater, boathouse, or lift must be set back a minimurn 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.)
do wish to waive the 15' set back requirement.
I do not wish to waive the 15' setback requirement—
(;E'ro erty Owner n rma#ioa)
f
� �..
Sigratvre r�Q
(-� QQ l
Print or Type Name
lec)
Mailing Address
(1-, 9. 2
City! State / Zip
(Riparian Property Owner Informtation)
S1g1nature v p4N Cr-j�.sT�r
Print -or -Type Nacne l
Mai ling Address
City / State / Zip

0
vs
l�
7009 1680 0000 22C5 9595
Al
r IiOWEB
02 , P $ 005.750
0001685'68 APR 2' 2012
61A LL`D FROM ZIPOOpE 28420
RETURN RECEIPT
,1111[11f,E4 11111 t, I It Ili i,II I � � 1 11111.9,1 /T`D

RUDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee Frei
Beverly Eaves Perdue James H. Gregson Seci
Governor Director
AGENT AUTHORIZATION FORM
Date: Ma",Z — I i+ ZoIZ
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
L i U ccl" C:4 cuA*\%
Owner's Mailing Address:
S.
Z9
Phone Number Oq�k `'t S"i " 3 tiy -s
Agent's Mailing Address:
tic
Z 8y `5
Phone Number n(&) �`� ' i S ZZ
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):
(my property located) at
This certification is valid thru (date)
C, LI
.. nate

US MAIL
CERTIFIED MAIL, - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: Lr'�Q
Address of Property:
(Lot or Street {I, Str et or Road, City
�&County) j ��
Applicant's phone #:`11V'���=, Mailing Address \�LQ�y boa- US' 3L�
u
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this perms
has described to me as shown on the attached drawing the development they are proposing. A description of drawin
with dimensions, must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. —`a
,Q
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. Correspondence should be mailed to 127 Cardinal Drive Ex'
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
if
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance o
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.)
do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.IQ
_,
(Pro erty Owner n rmation) .
RV -A aD-=U)
Signature
L fNAQ a Q
Print or Type Name
EL az �3h -
Mailing Address
�`��,�., ,,�, ► �C 29S2�
(Riparian Property Owner Information)
d]�h A.
Signature P4W lr- '..T
Print or Type Name
Mailing Address

HAND DELIVER 5:
ADIACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATAOUSE)
I hereby certify that I own property adjacent to
�, d G�G 's
(Name -of Property ner)
property located at Ja' �� M r `a''\A `�-
(Lot, Block, Road, etc.)
on C U r C)�\ > in ocon 1� ��� 2ti , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: r�� �� Mailing Address: +� 4 -Dr-3 271
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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.)
V1 do not wish to waive
I do wish to waive that setback requirement.
---------------------------------------- ---------------------------- -
DESCRIPTION AND/OR DRAWING OF PROP
OSIrD DEVEI;OPMI✓NT:
(To be filled in by individual proposing development)
aCv\-Q 4
&rowvf�
-------------------------------
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
'1
Signature
J011rs✓��sr+��imvr��

�\IbVJV
012
n
--AVQm/6\uN)--, mow,

pplicant: �Q ��%k?
1 � Permit #:
ate:
51Z2 IZ
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
bitat Name
DISTURB TYPE Disturbance total
disturbance.
Disturbance
disturbance.
Choose One includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
I
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dre ■ Complete items 1, 2, and 3. Also complete
item 4 If Restricted Delivery is desired.
■ Print your name and address on the reverse
Dre so that we can return the card to you.
— ■ Attach this card to the back of the mailpiece,
Dror on the front If space permits.
y
— 1. Article Addressed to: v
Dre
Dre' 1 i)Qrik
Dre Qf1� �9240
Dre
A. Signature
x „A ,
Agent
B. ved b ( ranted C. a p v
AY
D. Is delivery a different from item 11 ❑ Yes
If YES, ente4/delivery address below: No
U. ctype
rat Mail ❑ Express Mail
Registered alum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
Article
Dre 2. (Pans rfromNumb7009 1680 0000 2205 9595
(Transfer from
Drel PS Form 3811, February 2004 Domestic Return Receipt 1025y502 nt tsao
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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