59261D - Holding

-'CAMA / _'DREDGE & FILL
GENERAL PERMIT Previous permit #
►kNew -Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
3rized by the State of North Carolina, Department of Environment and Natural Resources
It
Coastal' Resources Commission in an area of environmental concern pursuant to I SA NCAC -7
ules�`hed.
nt Name 411/h , Project Location: County
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State Ml ZIP 9:�_r
Fax # ( )
zed Agent �� F�yon / [1(S AA-1-rP ►}l
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CW _ EW -- PTA =DES ` PTS
Street Address/ State Road/ Lot #(s)
Subdivision ��"" `
City �/ir�/ /y1 /;14 �ti ZIP
Phone # ( ) ''� River Basin
J OEA HHF
_ IH UBA - N/A
-
Adj. Wtr. Body 'A�/
(nn
PWS:
yes / no PNA
% FC:
yes / 1-941)
no Crit.Hab. yes / no
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Closest Maj. Wtr. Body�7��eh1//��r
�l✓'�
if Project/ Activity
e 6+0( f 7 ty
6�2'yt/G
f"Xl'
,r
IiYC / S
(Scale: / 4P
ack) length
-n(s)
pier(s)_
ength
tuber__
a / Riprap length_%
ig distance offshore Q
iax distance offshore
:hannel
jbic yards
mp
use/ Boatlift
3ulldozing
ie Length
not sure yes
gs: not sure yes
rium: n/a yes
14 no
Attached: yes A
ing permit may be required by: t/-1 lii// /K'I/�%��j ❑ See note on back regarding River Basin

REM MAY 0 8 2012
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FOF
Name of individual applying for permit `'`''A"i
Address of property d1)�/ ✓`/Z
I hereby certify that I own property adjacent to the above referenced property.
individual applying for this permit has described to me as shown on the attach
drawing the development they are proposing. A description or drawing, witf
dimensions should be provided with this letter of notification.
Please initi below if you have no objections.
�diG /r�lc
I have no objections to this proposal. /4�`t'
If you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 9
325-3W within 10 days of receipt of this notice. No response is considered t
same as no objection if you have been notified by Certified Mail.
WAIVER SECTION /V/&
I understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must be set back a minimum 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.
L2-Signature & Da1e t4AY 0 8 2C

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F&S Marine Contractors. Inc.
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pairs
/Fax:
email:
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DIlcant.
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Permit #: 0 /
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Ind in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
4tat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
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Dredge ❑ Fill XBoth ❑ Other ❑
'Z M)
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Dredge ❑ Fill ❑ Both ❑ Other ❑
I
SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON .
■ Complete items 1, 2, and 3. Also complete A
item 4 if Restricted Delivery is desired. ❑ Agent
X
I ■Print your name and address on the reverse ❑ Addressee
i so that we can returmthe card to you. B. Fillb ( nted N Date of Delivery
■ Attach this card to the back of the mailpiece, �,�
or on the front if space permits.
I D. s delivery address d'rff r t from 1? ❑ Yes
1. Article Addressed to: If YES, d
F enter I j❑
YNo
ewe f1fl, 0IJ/�
08
2012
3. ce_
❑ Registered ❑ Return Receipt for Me�h�ndlse
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? Para Fee) ❑ Yes
l
2. Article Number h / J / �/�f� bn Y 00 � / it /�`s�
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(Transfer from service label) CJG'
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑