38967D - Luciani

7y T.
CAMA / DREDGE & FILL
.ENERAL PERMIT Previous permit #
'-New Modification ❑Complete Reissue ElPartial Reissue Date previous permit issued�/7
rized by the State of North Carolina, Department of Environment and Natural Resources I �70�/
--oastal Resources Commission in nEoa of e ironmental concern pursuant to 15A NCAC ` CJ
t N Rules a ed.
it Name Project Location: County
t0 - I DO13 '1't�. Street Address/ State Road/ Lot # )
Gjirt State JN . lP/ 8 0 Al .
/ — H-ZC Fax # ( ) Subdivision
:ed Agent .i/1'10 ���'�'^ City ZIP
❑ CW ,,-'SkJW �-=Fi�A ❑ ES ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body Itle
❑ PWS: ❑FC:
yes / no PNA yes /Crit. Hab. yes / no Closest Maj. Wtr. Bod
moo A G
f Project/ Activity (�✓� �7 'f �f �rl ��j�%�d/ /� i�
Ick)length
n(s)
:ngth
amber
,d/ Riprap length i
g distance offshore
ax distance offshore
hannel
bic yards
np
I
ise/ Boatlift
i
,ulldozing
ie Length
not sure ye
s4'jig/
��
s: not sure yes n
Ium: n/a yes no
yes '"' n
Attached: yes no
ing permit may be required by:
/J.
See note on back regarding River Basin r

,*-YV06
bl�;�b lT'il
-v 'At Q�tt

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date i
Name of Property Owner Applying for Permit: { f E
Mailing Address:
s s 44v
I certify that I have authorized (agent)to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) i) ti
t�
at (my property located at)
This certification is valid thru (date) 2 C 1
f
—7-
Signature
Date

CERTiFIEO MAIL RETURN RECEIPT REQUESTED
DIVISION Of COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTWICATIONlVNAIVER FORM
w
Ar!r rt=s1 "�rP!*y 11�__+1t �..?:y,� t'`+• t ,}�,�-`..1.: �'+IG:
;gI or vrrr. s. Mrow c• Rzae" r..}: a Co .r•?t.
Ao1"ic drr tr na t:. , t;.l - 1 hlsr np r �.�l.�
I he►ety .e.'. Mot vw• FrcvvrtY ad;*mni to the abo:a refe.enced proper',. the cw4,vzua;
appty—, �o"' s oc^*+a hzm dcsc-.:.c%� L� ric as Blown or .^c e!acmec are,vlrg i!Se ceveoP!*'*nr
tte%, are A ¢e rrt lw U d'Ea±>,a lit-4t: 4=":'`_4Aws, Nill
1 h•.": r- rbicOw4n, t, thy►l tr•;k
M yn„ A*" ato"*—s M whir b be-Ing prop'a~' yo: j mWtt 4000y the Wvmfon of Coaster ira mWe "m
1D016j 0 rs",p wit!tin 70 dot's od IWOO of thX no&ct C"ema rnftmmoorr for DM apkms is
&waifab s of www.ncc04%w0wnpewant nvvcom'P _?cm AM}r Ar b> C&tuv.. t-#tiuRC`JAST Nu
rospensa is rc sidarpd "same ss — obj_ction it yrou have b— nWifi* j 4y CWt+•dlad AWl-
WAIVER S£CtON
I �mie"Star' ,'e� a pier. desk rtitxr h pl6,gs. brodK.va!er D�v7k _� 1sS, �r+ ►ft miiSt (7� 5{+ 'aiG�, f]
.r.•r,r,un *Ogg-'ce of , 5 Om. my area of ^Parzan. sctfts u-tess waived by ". ;If yoo; wml- r^
u8v.'4 r e i4 Kit, yciU ,glMl 1 -. * i''FxUPU'.Q tKar'(
i :ic• %i t, 'G wwve m+ I!, Selbaci, regterw'*'
__.. do not w•sn t-_ v4w,e ne "'
(Property Ow* Inforrnstion
i1
F41f 3r T.� ` ' ,
'"� ras•1i T
7�Venur nr h: -�'+r•
(Riparijo browny owwwr 4nfomwstkO )
/ / / �, N• � t�tlt SdN b�
30
A/C_

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 1d
Address of Property: ,'�JCV V i t 'i
(Lot or Street #, Street or Road, City & Count)
Applicant phone#: -9�3(u Z Mailing Address: I�Weo %vd
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.
l 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, breakwater, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature /� 1
Print or Type Name
)> l r /v �.�l �- r
Mailing Address
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address

Dplicant:
ate:
(J'z' -�5
Z-1164 all GZ t Permit #:
,scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat 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 Tina
disturbance.
Excludes any
restoration and/c
temp impact
amount)
/ !
w
Dredge ❑ Fill ❑ Both ❑ Other
U
g'
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 ❑
Dredge 0 Fill ❑ Both ❑ Other ❑