57579D - McLaurin

-,CAMA/ DREDGE &FILL
GnENERAL PERMIT Previous permit #
",*ew 'Modification Complete Reissue Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC L-)
EiRftles attached.
.nt Name Project Location: County
s /V Street Address/ State Road/ Lot #(s)
L-L State ZIP
# 6 6Fax # Subdivision
ized Agent rfCi-001i City
1112 LVEM zip J
Cw EW El PTA 2ES PTS Phone #
�d ( River Basin —1t1w
OEA HHF 1H El UBA E N/A Adj. Wtr. Body VVkAZ
at
F- PWS: 0 FQ Closest Maj. Wtr. Body —
yes / no PNA yes Ln-d Crit.Hab. yes no
of Project/ Activity t/ le I V f I-) i
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ding permit maybe required by: See note on back regarding River Basin
.1 4k*1 , 1 i C' A 7— .430 .,r /I A I — N J .-I, .47 � sw ��041

PM-03-2007 10:02 From: To:8929806
The purpose of this fora is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below, The LAMA General Permit applicadon procedures raquire that applicants provide ttie Division c
Coastal Managa cm confnmation that a written staternerit has been obtained sinned by the adjacent riparian property own
indicating that they have no objection to the proposed work of that the adjacent riparian property owners have been nodfh
by certified mail of the proposed work Often these forms are submitted to die adjacent riparian property owmrs by a mor
contractor or othtr individuals acting as an authorised agent on behalf of the applkznt.
This form was writ to you by the following individual or company designated by the applicant as an
authorized agent:
Signature
;-
Date
Name of Individual Applying For Permit:�—
Address of Property- .
( Lot or Street it, Street or Road)
(City raid County)
I hereby certify that I own property adjacent to the above -referenced property. The individual applying for this p
has described to me as shown on the attacched drawing the development they are proposing. A description or drat
with dimensions, should be provided with this letter,
I have no objections to this proposal.
If you have objections to what is being proposed. please write the Division of Coastal Maangemew
Cardinal Drive Extension, Wilmington. NC 28405 or call 910.796-7215 within 10 days of receipt of this n
No response is considered the same as no objection if you have beta noticed by Certified Mail
WAIVER SECTION
I understand that a pier, dock mooring pilings. breakwater. boat house or bout lift Must be set b
miaimum diswnce of 15' from my area of riparian access-.voksa waived by (Uyou wish to wai,
setback, you most initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
I dg M wish to waive the 15' setback requirement.
Sigh Date
NtDENR

Michael f, Eaft. Swum
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A NO land A Ckwo ert eint
29
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p►iCant: Me L f%Vk IN, DN I O
Permit #: 1 S—) /
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
ind 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 FINAL Feet
(Applied for. (Anticipated fir
Disturbance disturbance.
total includes Excludes any
any anticipated restoration anc
restoration or temp impact
temp impacts) amount)
Dredge ElFill ❑ Both El Other
Other �i
���
I � )
---
L/W
Dredge ❑ Fill ❑ Both ❑ Other ❑
c.J(/
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 0 Both ❑ Other ❑

HOLDEN DOCK & BULKHEADS
GREGORY A & DOROTHY HOLDEN
910-842-9732 HIS NCDL 4576438 HERS 6202642
1602 STONE CHIMNEY RD SW
SUPPLY, NC 48462
66-1215/531
640
s E jn�Y OCR
Otlefls on
Beck.
WACCAMA_•
BANK k aun Vl. �
S. l NC 28462 q' 1
1Szu�nu.waccamawbank.coin IF � l `" J
For nr
i:053 L L 2 L5 21:8000 L5?53011'046 39
WILDLIFE PORTRAITSO