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CAMA / ❑ DREDGE & FILL S` 592
iENERAL PERMIT Previous permit #
New % Modification - Complete Reissue Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources -
:)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Name A cl ai i � Y6k 0 $$a ��l Ul'�'w Project Location: County fyuns ni loi
2312 -T1 y1 of y Kau Street Address/ State Road/ Lot #(s)
�Ql'��"WGCCI Staters ZIP oZ+ Mo\vbC
( (y4 Fax # ( ) Subdivision
(0
,�AA L \,, y
�dAgent /`�1a✓lrrit �1I�rC✓S city 5`.E I, LA, ZIP Z
ElCW XEW P(PTA ❑ ES ❑ PTS Phone # O (r River Basin
ElOEA ❑ HHF ElIH ❑ UBA ❑ N/A Adj. Wtr. Body - 6a - nat n
❑ PWS: ❑ FC:
Closest Maj. Wtr. Body --
Project/ Activity
k) length FL -
(s)
er(s)
igth
nber
I/ Riprap length
distance offshore
x distance offshore
cannel
)ic yards
ip io
se/ Boatlift (. X'3
illdozin
e Length _
notsure yes no
s: not yes no
ium: n/a ves no
(Scale:
4ttacFjA:
Li-
ng p//er rrm✓✓i''t n
required by: !AAML ISK. I-d[ L«+-
`-I l i %^ .. ,. _. I � ii 1 10
❑ See note on back regarding River Basin r
_ . 1_ A. - _I, i �I,

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44
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North Carolina Department of E.nVironment and Natural Resources
Division of Coastal Management Dee freeman
Beverly Eaves Perdue Jam H.6rew Secretary
Govemor DMIor
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
elz
Owner's Mailing Address:
a1(2- nn�
`) a-7
Phone Number t� t 3 41 ` 3 q q
Agents Mailing Address:
Phone Number
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) of
This certification is valid th (date) $/ 3 o / f 2
�13
Property Owner Signature Date
127 CadW Drive ExL, WINngton, NC 2ti4U5
Phone:[phone]i6%FAX:[phone] b*wet:vr4w-aCCaastahnenagemGflLnet
Am Egaai aDV %A*ma%a Ac5W Empbfw
N L uolina

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G

US MAIL
CERTIFIED MAIL, - RETURN RECEIPT REQUESTED
DIVISION Or COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
fame of Property Owner: Y VNk C 1y f
Adress of Property:
(VIb hY ©e- S4.
6Yele-Vx
bid I -)-�C J�q6C�
(L.ot or Street #, Street or Road, City & County)
,pplicant's phone #: I ( ) � 3 - 31` ' 3 — Mailing Address:
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 drawin
vith dimensions. must be Provided with this letter,
-p 441ave 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.
Xilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no oblection 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
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
tppropriat blank below.)
*do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Own Infor tion)
Signature
Print or Type Name 11
Mailing Address
r"1 I f 1 l J C. mot, r✓
Property Owner Information)
M
SignaturV
Jul ie,
Print or Type Name
Mailing Address
I a1, IM I nn" N L

10 lc 11 : cos i'r n t-CSt.e"`,J' IU9-bt7 `t-UGJY P i
io-CVJie let. wort rmui i• Vim rLH1,0,-L1,0 O. 11,4 trm viY1--, V-C7'4V tU:1 tYJ`tbtx`f l'JCJ`t Y'. 1
U5 MAIL S
1
f
I
CE MD MMML RF iM U Ik' AFOI!XST D
DIVISION OF C I AL MANAGEhRM
ADJACENT RIPA1tL�N PERTY 4'V "R STATvNIEN-T ,
1 Name of Prop" Owner
Address of Property:
(teat or $UW #, treat or Road, City County)
I
Applicant's phone Mailing Achtress:
t hweby certify that I own property adjacent to the
has described to we as shoe m on the attached draw
refaced property. Tho itutividvxi applying far this permit
, development they Are pf0pa9ir►g A �o-rinhnn of dra�+�_
with dirn nsion mat h9 pto ON with this IMF ;
have no objections to this proposal. I hwe objections to this proposal.
if you have objections to what Is being proposed, you mast notify the Division of CDastal masagment MCK)
in willing withia 10 days of recelpt of this trance. t sctrrsspondmce should be mailed to 127 CardintA Drive &L
Wilmington, NC 28405-3M. DCH repreasntative� car also be coakeW at [phone]. No rcyponse is
QMid®red the same as no obRetioM if You hAle be_eh RatieeR byC 0fild MIR - -
W ATtR SECTION
l tin<lerstsnd that a pier, dock4 Mooring pilings, b.mtcv ter, bogWuse, pr lift must be sat back a.miaimunr.distance of
15' from my area of riparian access unlem waived by tno. (ifyou wish to waive the wtback, you crust initial the
appropriate blame below.) l
V4-L�I coo .Ash to waive the IS' sic back regr
I do not wish to waive the 15' set back
(grape Own Info lion) i
Signawre
Print or Type Name '
Kt cs
Maiift Address
i
City ! State I 21,p
Telephone Number
"%;qp(VVO/,- "
.-► .. ri --•ram i � � •� i W01.•a
�?� a v, e
City rs t74p� � �>3 r oq
Tel�ephane Nurnber ,

plicant:. % GV l Ou-' co, Vt S S� �%�,e V-'- Permit #:
te: S
/t Z
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
>itat 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)
Dredge ❑ Fill ❑ Both ❑ Other
3�
zG(a
Dredge ❑ Fill ❑ Both ❑ Other
Z
Z
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 ❑
2 - -4Z - C ["Js