60722D - NC

'CAMA / aREDGE & FILL ,/ NO. R
GENERAL PERMIT V Previous permit #
New ❑Modification Complete Reissue --Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources ^
HCoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
JwMules attached.
nt Name . - PA?oST i ���11� �-C�j OW14 JL Project Location: County_ L-k
D C 6N OA, AMC O IZD . 5AoA i N Street Address/ State Road/ Lot #(s)
__ IL—N—kjO State 'u. zip i i 0 CA 5A Irl-1. EkA(f '
O�U) Fax ## ( ) n t Subdivision r�
zed Agent ��i� �- Y�`(,WAf2:� rKt�i Q� ,City- �� �L ��7L1 11J ZIP
d CW _ EW p*TA IES PTS '. i`. Tl` ti i�+4hone # (_ ) River Basin
C OEA HHF ❑ IH - UBA N/A Adj. Wtr. Body C _ nat
C PWS: ❑FC:
yes / no PNA yes (fJ Crit.Hab. yes / no Closest Maj. Wtr. Body�� L�
A Project/ Activity il-I-PL11 C f-Lcw' 1 W ' } cy-s I.M 11-gio i;-:-iLC-7t1EL-
C'f (Scale:
lock) length
/
m/
m(s)
K X
ier s
length
umber
ad/ Riprap length �-
vg distance offshore
iax distance offshore PT T-
channel-
i�
ubic yards
imp
Ouse/ Boatlift
Bulldozing _
}/
ne Length
'
Q,
not sure yes
gs: not sure yes
i
mum: n/a yes o
v
yes
{
—
Attached: yes o
ling permit may be required by:
T, L.� �y }
��CO
A 1 i
t iy 1 i". i T'l C" L C 'I" ` _lI i I I .-a. /1 I
❑ See note on back regarding River Basin

Division of Coastal Mgt. Habitat impact Computer Sheet
licant: NC W► �S�SS►'�P�1--`� Permit #:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremeni
1d in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated Tina
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
itat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excludes any
restoration and/
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
g�
❑ Other
�
J
Dredge❑ ❑ Fill Both
■ Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Rn� ed Delivery is desired. X
■ Print your and address on the reverse ❑ Addressee
so that we can return the card to B. eceiy by (Printed ame) C. Date of Delivery
■ Attach this card to the back o e mailpiece, ` I —
or on the front if space per p r ( /� A C
4�7
b delivery address different from item 1? ❑Yes
1. Article Addressed to:O ESeterdelivery address below: ❑ No
tV
J �
S r--
U) 0— v
O Iw
O' u i
s Service Type
/! ❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2 7011 0110 0000 8664 9842
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
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.
1. Article Addressed to:
A.
�ell y -P (PP, 1,
zi l I � va L
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No

x64f1 11 8ftx144ft
Contractor: Richardson Construction
3235 Seacrest Ave SW
Supply NC 28462
910-842-5596 Office
910-367-0335 cell
[e-mail]
existing ramp
caswell basin
5ftx24ft
Owner: N C Baptist Assembly Project Description:place existing floating docks in
100 Caswell Beach Rd same location at caswell basin
Oak Island NC
910-278-9501 Office

�V*A
NCD84P*
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
Dee Freeman
Secretary
AGENT AUTHORIZATION FORM
Date: / ' Z% /
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Owner's Mailing Address:
Agent's Mailing Address;
V
Phone Number AY 0) '-Ijn%
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
Eto
(my property located) at / DO A4 Sr, ►C (( 6 E,6C H Ag-AIC)
This certification is valid thru (date) .
Property Owner ignat re ��� Date

cd /1" . /--
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ame of Property Owner:
3dress of Property: jg�C3 Q_l ( ?ec"C -rjL Qnri4��C
(Lot or Street #, Street or Road, City & County)
pplicant's phone 9: �/I _a �� " 9�1 Mailing Address: tw �5k, �� �� �•
t-)Dt .itJ0►,� IUG���t4�5
iereby certify that I own property adjacent to the above referenced property. The individual applying for this per
is described to me as shown on the attached drawing the development they are proposing. A description of draw
ith dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
you have objections to what is being proposed, you must notify the Division of Coastal Management (DC]
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive ]
lilmington, NC 28405-3845. DCl�I representatives can also be contacted at [phone]. No response is
)nsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
.understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
i' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
)propriate blank below.)
M9 I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
'roperty Owner Information)
ignature
a
rint or Type Name Afe
su-)
k,
Print or Type Name
C� 5 R0 cr e_�.
failing Address
Mailing Address