59598D - Kennedy

(CAMA / 'DREDGE & FILL
3ENERAL PERMIT Previous permit#
New , Modification El Complete Reissue El Partial Reissue Date previous permit issued
fized by the State of North Carolina, Department of Environment and Natural Resources ]T i-, . (7_C� -oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
WRules attached.
it Name.jvI!fit l it ;: Cis
ul IS �' State N C ZIP +,C1
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❑ CW V�W [:PTA
ElOEA ❑HHF ❑ IH
❑ PWS: ❑ FC:
yes no PNA yes no
f Project/ Activity
irkl Innoth k,6 X 1 i J
El
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes no
rys+(Lt-1 O&V CI
Project Location: County 'F� i�U Y15 y�11 LAC.
Street Address/ State Road/ Lot #(s)
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Subdivision N/f�
�Ity 5a VY E ZIP G(t.Y1ti.1_
Phone # (910 )443 - T)C1 3 River Basin LOYN 1
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ing permit may be required by: ©mkt i F I Isif, ��Ji Q` c El See note on back regarding River Basin r
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual 1
Address of Property:
(Lot or Street #, Street or Road)
v.
(City and County)
hereby certify that I own property adjacent. to the' above -re ferenced property. The indivi(
applying for this permit has described to.me as shown on the attached drawing the development
A
re A description or drawing, with dimensions, should be provided with this letter
II have no objections to this proposal.
objections to what is being proposed, please write the Division of Coy
Management, 127 'Cardinal Drive Extension, Wilrimington, INC 28405 or call 910-7964,
within 10 days'of receipt of this notice. No response is considered the same as no.objectii
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must it
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (I.
wish to Nvaiv-e 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.
Z
,&TWA

i
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVERFORM
Name of Individual i
Address of Property:
(Lot or Street #, Street or Road)
r's. �—
(City and County)
T-TierebyYcertt that I own rope �YadJscent t ,I tile a ove-reference
prop rty-77 He—"m wt t
applying for this permit has described to.me as shown on the attached drawing the development th
are propo5ina A description or drawing, with dimensions, should be provided with this letter.
v '
N� I have no objections to this proposal.
If you have objections to what is being proposed, please Nvrite the Division of Coas
Management, 127 Cardinal Drive Extensions Wilmingtoo,.NC 28405 or call 910-796-72
within 10 days of receipt of this notice. No re�poase is considered the same as no objectioi
you have been notified by Certified Hail. 1
WAIVER SECTION
i
i
I understand that a pier, dock, mooring pilings, brenkwater, boat house or boat lift must be
bck a rninimum distance of 15' from my arel ¢f riparian access - unless waived by me. (If1
wish to waive the setbadl,�,-you must initial the appropriate blonk below.)
i
I do wish to waive the 15' > etback requirement.
i
I do not wish to waive the 1 5' setback requirement.
lj:�� I ( I,4-
Sign Name batel
Print Name Ar,.M-A

MCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Gael F. Easl-y, Governor Charles S. Jones, lirecW
Authorized Agent Consent Agreement
Iffiftm G. Ross Jr., Se
hereby authorized to act on my befit
(Fi Med a of AgenP
xler to obtain any LAMA it(s) rewired for the prop6r�w listed below. The authorization is limited tO
,ific activities described in the attached sketch.
OATION Of PROJECT:
)PERTY OWNER MAILING ADDRESS:
o CG A j- G- 6eA(4 SC
rHORlZEG AGENT MAILING ADDRESS:
�oz� C7oI���Y� T19-yul .14---L�qt4
V-blbum
PONE NO. � Ly O 0 -- 2- /6 ( 1
T4?
PHONE NO. LLI)­
rature of Property Owner:

C Division of Coastal Mgt. Habitat Impact Computer Sheet
iplicant. Kju K&Ines Permit #.-
Ite: •
scribe 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
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
3itat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excludes any
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
Dredge ❑ Fill ❑ Both ❑ Other
220
CD
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 ❑
o CERTIFIED MAILW RECEIPT
Dredge El Fill ❑ Both ❑ Other El�
D.
Dredge [IFill ❑ Both [IOther El
Ln
nJ Postage $
ED Certified Fee ' )ll

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