60628D - Hibiske

gAMA / !--'DREDGE & FILL N O • 6 Q
-EN ERAL PERMIT Previous permit #
VNew Modification ❑Complete Reissue Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1 L
ules attached.
nt Name �! LamI tj� ` l Project Location: County �`t /�/_� t : r C
s tj1 I) �k 1W)e \(�// �{ Street Address/ State Road/ Lot #(s)
FLU t ALE State ZIP�-- /t;'S i fri l t z S 11S I X jAil+y
() Fax # () ��,,SJJubdivision
zed Agent (. (y w ,�'tm ity &-y, L.l� ZIP Z-f�4
ew 141tW �7A ❑ ES - PT �` Phone # (- ) River Basin 6 l
OEA HHF - IH = UBA N/A I
_ Adj. Wtr. Body tV (.(I1)SLU � C!L J;? t t,.l:.12.
PWS: ❑FC: �-
yes / , ' PNA 6/ no Crit.Hab. yes /ro
Closest Maj. Wtr. Body- C /� � r "
A Project/ Activity Evl- r (� {1A MV "lwu CA L V_' j` T C NS[YVC T
I Kra-�! n t (Scale: I /_;
/
ock)lengthp =K. ?Ct J-t
+'- - - —
r
ength�r
umber -
ad/ Riprap length
✓g distance offshore
iax distance offshore
:hannel
ibic yards
imp
use/
Bulldozing
VU Ate" 2A x (o'
1--
00
(1i'a
�tS
.-
ne Length �� I _ _...:.-
not sure yes
gs: not sure yes o .
�rium: n/a yes o(oZ
yes o -- --
Attached: yes not
ling permit may be required by: y ► l.�l.��' �� ❑ See note on back regarding River Basin
I
I {�; f

Division of Coastal Mgt. Habitat Impact Computer Sheet
Acant: Permit #:
e: '712'z/i Z.
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
nd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fin,
ritat Name
DISTURB TYPE
Choose One
Disturbance total
includes any
anticipated
disturbance.
Excludes any
restoration
Disturbance
total includes
any anticipated
disturbance.
Excludes any
restoration and/
restoration or
and/or temp
restoration or
temp impact
temp¢impacts
impact amount)
tern impacts)
amount)
Dredge El Fill El Both ❑ Other
J
( Z0
Dredge ❑ Fill ❑ Both ❑ OtherA ❑
SENDER: COMPLETE THIS SECTION•MPLETE
THIS SECTION ON DELIVERY
■ Complete items 1, 2, and 3. Also complete
A. Signature
Item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
❑ Agent
1p /'c^ ❑ Addressee
B. (Panted Name)
`� J
C. Dajeo Delivery
1. Article Addressed to:
Fa.fr� ll
6. is delivery address different from Item 1? Yes
If YES, enter delivery address below: ® No
gco Ctat►usluU C�
f_=o�ytt✓� 1v7 2 i a 37
3. Service Type
{$I Certified Mail ❑ Express Mall
❑ Registered ® Retum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? Wxhe Fee) ❑ Yes
2. Article Number 7007 0220 0003 7190 3768
(rransfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M_1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

CERTIFIED MAIL---ETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of individual applying for the permit: (A )' kS u u 1 << i [� �.�✓� c «3_
Address of property. /� Flo
(Lot or street#, street of road)
(city &
I hereby certify the 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, should be provided whit 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)
796-7215 within (10) days of receipt of the notice. 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, lift or
sandbags must be set back a minimum distance of 1F From my area of riparian
access unless waived by me. (If you wish to waive the setback, you most initial the
appropriate blank below.) -
1 do wish to waive the 15' setback requirement
I do not wish to waive the 15" setback requirements
YLDate

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
�7Authorized Agent Consent Agreement
2728 N. 23r° Street
DUNCAN Wilmington, NC / .11
MARINE 28401 �/t�%CS �L1Lt ige&I is hereby authorized to act on my behalf
(Pmi Akw eofAyeM
in order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
specific activities described in the attached sketch.
LOCATION OF PROJECT:
1051 Marshside Way
Belville NC 28451
PROPERTY OWNER MAILING ADDRESS:
Hibiske
1051 Marshside Way
Belville NC 28451
AUTHORIZED AGENT MAILING ADDRESS:
0) 2728 N.23r° Street
DUNCAN Witinirrgton, NC
MARINE 2saot
Signature of Property Owner.
Signature of Authorized Agent.
Date: l - 9- Z 012-
PHONE NO
NO. .g/D- 7-13-7F0/
127 Carnal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: [phone] FAX [phone] t Internet: www.rrcooaslai nanagementner
An Equal Oppoft* 1 Mum!" Action EffoWer - 50% Recyded 110%Post Gormww Paper

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