59166D - Lewis

-1 CAMA / -- DREDGE & FILL
3ENERAL PERMIT Previous permit #
_New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_
)rized by the State of North Carolina, Department of Environment and Natural Resources y
CoAstal Resources Commission in an area of environmental concern pursuant to 15A NCAC / �%
❑ Rulas attached
it Name
RG� 4 f State/ ZIP r�f'
Fax # ( )"
ted Agent Jai'! 10 44at .,
i Ll CW 0 EW ❑ PTA -, ES ❑ PTS
OEA = HHF _ IH - UBA n N/A
PWS: ❑ FC:
yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County n. P�
T-
Street Address/ State Road/ Lot #(s)
Subdivision
City 1, rztl ZIP
Phone # (NQ) 5 — a�River Basin
Adj. Wtr. Body / nat
Closest Maj. Wtr. Body
f Project/ Activity ,`1C, '� •F i'Z^is s. r, j� 4;1"1,1 c;
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
CJ i '-�
Address of Property: (� ,&e SN mels �{2
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 916 `S-a 0 - J d-
2yy�
CAN S, C
Mailing Address: //'7 1Kyl ft4,C s�-
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 or drawing with dimensions must be provided with this letter.
i�I have no objections to this proposal. I have objections to this proposal.
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. Contact information for DCM offices is
available at www.nccoastalmangement.neticontact—dcm.htm or by calling 1-888-4RCOAST. 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; t:reakwater, 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 appropriate blank below.)
V I' 1:z I do wis h to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
l�� /
Signature
A7)}R& L-e �s
Print or Type Name
11 a a ��, ('q 4 S�-
Mailing Address
(Riparian Property Owner Information)
Signature
01-� m I= �� C
Print or Type Name
2 a e. 5 �-
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: AOK bowl s
Address of Property: )0/16e- !JJ',vezmls 1,ex 6 �' /(o D ONJ
(Lot or Street #, Street or Road, City & Co nty)
Applicant phone #: `) j L' 6dL)- moo? �6 _ Mailing Address: ��07 ///C
ti C_ �'YG
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 or drawing with dimensions must be provided with this letter.
Ae!� I have no objections to this proposal. I have objections to this proposal.
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. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that c pier, deck, mooring pilings, oreakwater, 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 appropriate blank below.)
do wis h to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
90-0�
Signature
/WN,40k-I Lew;
Print or Type Na/me J
Mailing Address
(Riparian Property Owner Information)
Signature
Print or Type Name
- -�-Dl -5,:4 i 7L �i✓
Mailing Address

And Page
sii� ,

olicant:
te:
Permit #:
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 ❑
Dredge ❑ Fi Both ❑ Other ❑
�Q�i
SOdt%
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 ❑