59196D - Miner

CAMA / DREDGE & FILL 59
GENERAL PERMIT Previous permit# /L'%
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
'sized by the State of North Carolina, Department of Environment and Natural Resources /
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rubs attached.
it Name }�I///� i ��" % Project Location: County n_S
/:714' StateAltl ZIP Z �C>3
; .> Fax # )
zed Agent 1/A-" Y
❑ CW [ EW a PTA ❑ ES Ll PTS
❑ OEA HHF IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes no-,PNA yes Co)Crit.Hab. yes / no
Street Address/ State Road/ L t #(s)
Subdivision ,
City L/ ! ZIP745yt
Phone # ( ) River Basin 60'/
Adj. Wtr. Body f' nat
Closest Maj. Wtr. Body
f Projgct/ Activity &4^SJ 4l/
)ier(s) 7
mgth
ember
Riprap length
g distance offshore 'T
ax distance offshore 7
ie Length
not sure yes
;s: not sure yes sip
rium: n/a yes C�q/
yes
Attached: es no `
ing permit may be required by: _
See note on back regarding River Basin r
r-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to _ A t, 3 e(,t- . /I ttJe (Z is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.) F
on _ C,/� N t-- , in Su [ GI '`l ly N51- a w , N.C.
(Waterbody) (Town and/or ounty)
Applicant's phone #: 5-18 '?L .5) - 33 `f Z— Mailing Address: Pe- B o �- �- -d 7
h�2X r4 CIZ -e
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Po 36n 7
Mailing Address
(Riparian Property Owner Information)
td��Cqi--
Signature

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: AI / N C-R
Address of Property: `(fig s % -5'u kr C, —%L O4SCo uv
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: .S / & a-5-1 " 3 3 9J Mailing Address: Pp B a,)— sY7
Il�o � f rf Ci2 C eK
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe:
has described to me as shown on the attached drawing the development they are proposing. A description of draw
with dimensions, must be provided with this letter.
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 (DC:
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response h
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 distano
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signature
Print or Type Name
(Ri Pro erty Owner Information)
Signature
Print or Type Name
Mailing Address
� 2 (Zz. s e.ze
Mailing Address

)plicant:
rte:
Permit #: � 7) r
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
DISTURB TYPE
bitat Name Choose One
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL Feet
(Applied for. (Anticipated final (Applied for. (Anticipated final
Disturbance total disturbance. Disturbance disturbance:
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)
�/✓ Dredge ❑ Fill Both ❑ Other ❑
�S
S—S
Dredge ❑ Fill ❑ Both ❑ Other
� 10
Vl/
Dredge ElFill ❑ Both ElOther
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 ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
lichael F Easley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr.. Secret
is hereby authorized to act on my behalf
(Printed Name of Agent)
)rder to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
�cific activities described in the attached sketch.
,CATION OF PROJECT:
H 0 � �Pi ��
OPERTY OWNER MAILING ADDRESS:
PHONE NO. Syi ZS'l -i—
AeTMAILINt.�
THORIZED ADDRESS:
Ay�I n" bum I, z I LL�
PHONE NO
fnabirp of Prnnorty nwnnr