60727D - Norton

_"CAMA /. ❑ DREDGE & FILL I/ No. 60'
3"ENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue --Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
`Rules att.ched.
t Name L i Project Location: County (,
u (a h Ct� Street Address/ State Road/ Lot #(s
q Swett ZIP Z$�$ ' �2.2 %Vf YV1tw r1Vf_ SW
�� I✓ Fax # () Subdivision !\
ed Agent C{�► G City . �h0.�1� r� ZIP �'�
CW )<EW PTA ❑ ES ❑ PTS Phone # (°I��) Z•C1�' 19S River Basin
ElL.�V `M
OEA ❑ HHF ❑ ❑ IH ❑ UBA N/A Adj. Wtr. Body sY 1(il 6k �)JRi (nat G
yes / no PNA yes no Crit.Hab. yes / no Closest Maj. Wtr. Body � Vy,'v
f Project/ Activity
('mt, o)i Y WIC V 1a-
0
(Scale: ` c
e Length
not sure yes ; no
/-
S: not sure yes no --�•" - -_- .. .
iumn/a : yes no
yes no X Y +y
Attached: yes r' no ��—.:�____ { 4' .� _
1
ng permit may be required by: �V i's4�' I ( �• L' I\ AI- ❑See note on back regarding River Basin r
-i1(-1t\[\1 n..s ,Il .(l.. I•�._._i �l__L_ �.,�; i �. .,I <. I 1=...

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�jCDE . R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
Dee
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: .
Name of Authorized Agent for this project:
n f or ITYi Le 4i av►
Owner's Mailing Address:
Phone Number
Agent's Mailing Address:
_ 2g
Phone Number
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):
(my property located) at
iE
This certification is valid thru (date)
Z 3o Jl
,.,___..._. Date

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: k-N, cAa) s1
Address of Property:
(Lot or Stre t #, Street or Road, Cit & County)
Applicant's phone 4: — % Mailing Address: 3AAS 1 \,I 2-1\ T
� yy-� \� -2--t3S'�
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this per
has described to me as shown on the attached drawing the development they are proposing. A description of drawi
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 (D0
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 is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that pier, dock, mooring pilings, breakwater, boathouse,.or lift. must beset back a.minimum.distance
15, from my area of riparian access unless waived by me. (If yqu 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 Owne I formation)
ignatum
Print or Type Name
Mailing Address'
2A35�&-
(�R(i)parian Property Owner information)
Signature
G n d R, M
Print or Type Name
Mai ' g Address _
;e -)cA iicv� y s

US MAIL
CERTIFIED )MAIL — RETURN RECEIPT RE UESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEME1
Name of Property Owner: U<-\ I t�U 1 A U 6 N
I
Address of Property: ,2
(Lot or Stre t #, Street or Road, Cit & County)
Applicant's phone #At-13� r(D�]b7 Mailing Address:
\�
��-1
?11 \ -
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this per
has described to me as shown on the attached drawing the development they are proposing. A description of drawi
with dimensions. must be Drovided 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 (DClr
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive I
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. 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
15, from my area of riparian access unless waived by me. (If. yqu 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 OwneX I formation)
� 6"
ignature
-�Q �,AG Vert
Print or Type Name
Mailing Address '
iA .h^h 0 i -[ \ t `L z sus
(Riparian Property owner tntormauon)
Ygnature
Print or Type Name
, o a /7"M o ove Ge�
Mailing Address

Os�,-2e/2012 lb. 41 91r37549146 TAWA FAIRCI-OTH
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Rt�(.3EIVED
DCM WILMINGTON, NC
SEP 0 4 2012
50..26
County, NC
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DCT-O?-z012 08:59 From:
}Rif .
I'
To:25e7275127 P.2/2
Consent for Use of Genera! Permit 7H..1200
Lot Number/Address: �w
cnuai'y:'- —Y-sz � gubdMsioa:
Criterie:
(check all thm apply)
przriaary Nursery Area,
Tess than 2.0ft deep.
Orcater than 2.0 but less than 3-Ott.
g $ubmaVd Aquatic Vegatuliott.
© Dottom babitat.
C6mmeats, ^ n
0
Decf
i Tss' eQ=eral Permit
a BIC ate to Major Permit
x
l b 2- i
of mine Fisheries Representative Doc

Applicant:
Date:
r ,
Permit
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/c
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other
WI Dredge ❑ Fill ❑ Both ❑ Other
,omplete items 1, 2, and 3. Also complete
em 4 If Restricted Delivery is desired.
'rint your name and address on the reverse
o that we can return the card to you.
,ttach this card to the back of the mailpiece,
r on the front If space permits.
rticle Addressed to:
me l�n�
UV
Number
A. Signature
X _ / ❑ Agent
❑ Addressee
B. eceived by (Printed Name) C. Date of Delivery
Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. ervioe Type
Certified Mail ❑ ress Mail
❑ Registered Retum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7009 1680 0000 2205 9649
3811, February 2004 Domestic Return Receipt
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
102595-02-M-1540
(Domes!ic Mail Only; No Insurance Coverage Provi
For delivery information visit our website at www.usps.co
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