59234D - NC

[�C'AMA / LTDREDGE & FILL _- , 5f
G-ENERAL PERMIT Previous permit#
fli`,lw . ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
iorized 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 ~� . +
Rules attached.
tnt Name i(:Ic.C,-CCc u S- Project Location: County 61( �k wt w i c --
-d-a
C ON Street Address/ State Road/ Lot #(s)
wai State N `.ZIP XS4'y� h4 i els 0 Se
# &(J) 7U3 Fax # ( ) Subdivision
ized Agent I City Atcyj ZIP-2&!+
d ❑ CW "EW PTA dtS J PTS Phone # (f 110) S-7I - 6j 3 River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body CAJE I- `I tf
ElPWS: ❑FC: � na
yes /� PNA yes /® Crit.Hab. yes / no Closest Maj. Wtr. Body�-
:A Project/ Activity 2-7 9 L, : rye
(Scale:
lock)length
-m(s)
pier(s)
length
camber
Bad/ Riprap length 2� r
tvg distance offshore
nax distance offshore (l�
channel
:ubic yards
amp
ruse/ Boatlift
Bulldozing
ine Length i] 0'0
not sure yes �o
►gs: not sure yes ►g
xium: n/a yes r�
61 no
Attached: yes no
ling permit may be required by: &&V I C4,e - ❑ See note on back regarding River Basin
.1 c---e_' iian . / — 1l1:�' Y k Ir r- -11L L . —1 1 rii A. i

1, 2012 4:38:26 PM
AP DOCUMENT GENERAL INFORMATION
FUNCTION: ACTION:
HISTORY:
DGI
06/11/2012 16::
ENTITY 46PT VENDOR/EMP NUMBER: 566000372 40
/EMP SHORT NAME: DENR DOCUMENT NUMBER CAMAPERMIT/6-1,
MENT DATE : 06/07/2012
ROL NUMBER : 4219
MENT TYPE : INVOICE
MENT STATUS : PD-FULL
ENCY CODE
S DOC AMOUNT
NT PAID
TY CDE/TRIP NBR:
EFERENCE
APPROVAL CODE
S APPROVED
CONTROL DATE : 06/08/2012
APPLICATION AREA : MC
DATE ENTERED : 06/08/2012
DATE LAST UPDATED: 06/08/2012
600.00 PROV ACCTG DATE .
T MESSAGE: BRUNSWICK TOWN /FT.ANDERSON GENERAL-CAMA PERMIT WINNABOV

1-2012 12:16P FROM:BRUNSWICK TOWN STATE 91038=06 TO:3953964 P.
ADJACENT RIKPARIAN PROPERTY OWNER STATEMENT
I hucby certify flint 1 own prop" adjacent to6
(1rlame or Property[[Owaer)
proptrty lour! ac ASAVJ r
t, Blvc Read, etc.)
on in 4N.C.
(Waterbody) (Town studlor County))
j'
Applbesat's pion #: 3 — k3 WUlug Address:%%q Ific.G .
�9
lic has described to me. as shown below. the development he is proposing at that location. and. I
have no objeWom to biis proposui.
DFSCRTMON ANDJOR DRAWING OF PROPOSM DZVF,LUPMW4T:
t70 beflood In by proper& oavrerpwasme demft )
(Informatio for PtoWrrtt Owner A plying
for Ptrtait) ���i �S� 1�#:tSa1
PA
Mailing Address �[`•�
U�In���9
CityJStatcrzip
_i 1
Teleph w N=V=
Signature Da c
RECEIVED
DCM WILMINGTON, NI
MAY 2 4 2012
(Riparian Prop" OvrnerTnformetFoo)
Signature
Print or Type Namc H44 r -A5%
1° "YAJ/ U4.-
Telephone Number
.�.
Date

■ Complete items 2, and 3. Also complete
item 4 If Restricted Delivery Is desired.
A. sign to
■ Print your name and address on the reverse
- {
❑Addressee
a I)ece ed b (Prfn ed Name)
C. Date of Delivery
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front If space permits.
D. Is delivery address d'rfferent from item 1?
If YES, enter delivery address below:
0 Yes
❑ No
1. Article Addressed to:
Yilb I so
CA o n,- [ .S . Ca i JsS+ 6
"f LV f i�Ct�s��ar'�a 10 T
3. Service Type
n S
Certified Mali 0 Express Mail
❑ Registered ElReturn Receipt for Merchandise
.InU )fl�
LAI_U / p, (
❑ Insured Mail ❑ C.O.O.
4. Restricted Delivery? (Extra Fee)
❑ Yes ^
2. Article Number
(Transfer from service rebel)
PS Form 3811, February 2004 Domestic Return Receipt io2595-02-M-1540

m �•
tom•
ru
r-I Postage $ -
C3 Certified Fee ii
M Return Receipt Fee
CO (Endorsement Requimd} .. - Postmark
Here
Restricted Delivery Fee
p (Endorsement Required)
O
mTctat Postage & Fees $
,-, 'Send. ,
f� waoeox,vo. ,
--

plicant:'l tL. (LlEw�
te: Permit #:
i5/I,Z
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
Ind 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 FINAL Feet
(Applied for. (Anticipated fin
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and,
restoration or temp impact
temp impacts) amount)
Dredge ❑ Fill [Both ❑ Other ❑
2 A 0
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 ❑ Fill 0 Both ❑ Other ❑

STATE OF NORTH CAROLINA
Department of Environmental and Natural Resources
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
FILE ACCESS RECORD
SECTION C W
TIME/DATE 9n1f, - S-- $ — I `i
NAMES�—
REPRESENTINGRiW6 C2�;V Stt,�T►> I
Guidelines for Access: The staff of Wilmington Regional Office is dedicated to malting public records in
our custody readily available to the public for review and copying. We also have the responsibility to the
public to safeguard these records and to carry out our day-to-day program obligations. Please read
carefully the following guidelines signing the form:
1. Due to the large public demand for file access, we request that you call at least a day in
advance to schedule an appointment to review the files. Appointments will be scheduled
between 9:00am and 3:00pm. Viewing time ends at 4:45pm. Anyone arriviniz without an
appointment may view the files to the extent that time and staff supervision is available
2. You must specify files you want to review by facility name. The number of files that you
may review at one time will be limited to five.
3. You may make copies of a file when the copier is not in use by the staff and if time permits.
Cost per copy is $.05 cents. Payment may be made by check, money order, or cash at the
reception desk. Copies totaling $5.00 or more can be invoiced for your convenience
4. FILES MUST BE KEPT IN ORDER YOU FOUND THEM. Files may not be taken fi-om
the office. To remove, alter, deface, mutilate, or destroy material in one of these files is a
misdemeanor for which you can be fined up to $500.00. No briefcases, large totes, etc. are
permitted in the file review area.
5. In accordance with General Statue 25-3-512, a $25.00 processing fee will be charged and
collected for checks on which payment has been refused.
1. WiV D
0
FACILITY NAME COUNTY
4.
A

1, 2012 4:38:37 PM
kP DOCUMENT PAYMENT GENERAL INFORMATION
DPG
FUNCTION:
ACTION:
HISTORY:
06/11/2012 16:3
3E:
ENTITY
46PT
VEND/EMP NBR:
566000372 40
/EMP SHORT
NAME:"
DOCUMENT NBR:
CAMAPERMIT/6-12
KENT DATE
: 06/07/2012
PAYMENT NBR:
001 PRTL PYMT NBR:
IND AMOUNT
S TAX/VAT
S TAX 2
S TAX 3
JHT
TIONAL COST
S INVOICE
ENT AMOUNT
WE.
600.00
600.00
ENT TERMS : NET PAY IMMEDIATELY
ENT DATE : 06/08/2012
ENT ROUTE CD :
OR NUMBER
ON CODE/DESC
VAT INCLUSIVE N
EXPENSE IND
GL EFFECTIVE DATE: 06/08/2012
EXTRACT DATE
ACCRUAL CANC DATE:
CURRENCY CODE
DISCOUNT TYPE
NOT TAKEN
DISCOUNT TAKEN
PAYMENT STATUS
PAID
_,x T ' -R� AR
0000973-72 j
PAYMENT TYPE
ELECTRONIC
HANDLING CODE
ONE INVC PER PYMT:
BANK ACCT PYMT CD:
IGO