59178D - Lee

ICAMA / �] DREDGE & FILL
GENERAL PERMIT Previous permit#
New El Modification []Complete Reissue EPartial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
�oastal Resources Commission in an area of environmental concern pursuant to 1 SA NCAC 4' �Zt>Q
� ; . -, ❑ Rules attached.
it Name J i�� Project Location: County UYIS
6V-4 Win n Street Address/ State Road/ Lot #(s)
statee ZIP $2V05q
`('ti')��% ij.'`C`� Fax#()
:ed Agent AA I t d Ma O'm Omw L+V&
❑ CW 4 EW PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF !❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / no PNA yes rno) Crit.Hab. yes #'no
F Project/ Activity
bic yards
se/ Boatlift I Ic
rat
ulldozing
e Length b
not sure yes
s: not sure yes
ium: n/a no
4ttached: yes
A IZY Hm
City JrW 1 !c,{+s ZIP
Phone # River Basin iLJM
r
Adj. Wtr. Body �1 nat
Closest Maj. Wtr. Body W
(Scale:
ng permit may be required by: Dh(kJ1 0 k / Ur AS [ ❑ See note on back regarding River Basin r
iil :fit iKl11411A nll r . t 1 L-7.1 CA-1, A All !„�. 'j .I

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 3 /)a
Name of Property Owner Applying for Permit:
ZeC,
Mailing Address:
/qq5
tiG a �
I certify that I have authorized (agent) A2,j )e� l to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) fio �I
at (my property located at) A14j1c,/
This certification is valid thru (date) ��/a
3

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property:
or Street #, Street or Road, City & County)
Applicant's phone #: 209) � -3 * Mailing Address: I !�—V4 J!6Z
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
has described to me as shown on the attached drawing the development they are proposing. A description of dr,
with dimensions, must be provided with this letter.
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 (Di
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Driv
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response
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, or lift must be set back a minimum distar
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial th
appropriate blank below.)
I do wish to waive the 15' set back requirement.
P� I do not wish to waive the 15' set back requirement.
(P erty Owner Information)
Sign ture
�h
Print or ype Name
l 411_I 5 L h n O
'paria rope Owner Information)
l tur
R14
Print or Type Name
Mailing' Address " Mailing Address

CERTIFIED MAIL - RETURN RECEJT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property:
j GG (Lot or Street #, Street ortRoad, City & County)
Applicant's phone #: `� ( O� 3 33/ y Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
has described to me as shown on the attached drawing the development they are proposing. A description of dr
with dimensions, must be provided with this letter.
fI 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 (DI
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Driv
Wilmington, NC 28405-3845. DCM representatives can also be contacted at (910) 7%-7215. No response
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, or lift must be set back a minimum distal
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial tb
appropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
i
igna re
�41
11Zee_,_
Print Type Name
1 y q Lyhn Lnc k &
Mailing Addres
r(Ripari Prope Owner Information)
ignature
�LL1Ll l A� �ii7 �/� /✓� ��II'�
Print or Type Name
Mailing Addres
r

ilicant: I l �l Permit #:
U
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
DISTURB TYPE
tat Name 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)
WDredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge tEl Fill ❑ Both [IOther ❑
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 ❑