59284D - Ruckenbrod

ICAMA / ❑ DREDGE & FILL ``''
aENERAL PERMIT Previous permit #
N,New ❑hodification -Complete Reissue ❑Partial Reissue Date previous permit issued
>rized 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 M
Rules attached.
itName ea �'` ,r KUC6V\-1Onk Project Location: County by, ►"-V", •l.i�
2C�Uavky-5 Lane, Street Address/ State Road/ Lot #(s)
VolState3C ZIP N2Z 16 /lV
Fax # ( ) Subdivision NAl
ted Agent A weA 1 a In ru ('AY�� Ovm City Skwzip
I ❑ CW ,EW f,� PTA ❑ ES ❑ PTS PKbne # Zs) River Basin Lv000
❑ OEA L HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body J�LIU�1 �V i r (nat ,
❑ PWS: ❑ FC: _ AA
yes /6no PNA yes % no Crit.Hab. yes �Mo Closest Maj. Wtr. Body wy)
3ulldozing
I�A MP J 4'�4 1(o
bo., ie Length
not sure yes no
gs: not sure yes no �-
rium: t ~tea r j no
Hy�es
Attached: no ' /i1/IIOWI'Kt +
ing permit may be required by:
❑ See note on back regarding River Basin
(A. _f, — - . 1. L

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: rt4o"lly)(0 U
Address of Property: L t o
(Lot or Street #, Street o oad, City & County)
Applicant phone #: 76g -6 3 ZY- -'L/ Mailing Address: (c,'r4S Lit
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
X, 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
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. 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 of 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' setback requirement.
/)c'-4do not wish to waive the 15' setback requirement.
l
(Property Owner Information)
J;�
Signature kadl&vd�
Print or Type Name
(Ri
or Type Name
Owner Information)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: _1 �9 �p 1' i► i/ ,A an & L 41
(Lot or Street #, Street or%tRoad, City & County)
S it/ 6W1O�e. A
Applicant phone #: %O 4- D�,3q - / f Z f Mailing Address: ls(uri�l �Gf� L N
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, 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
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangementnet(contact dcm.htm or by calling 1-888-4RCOAST. 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 of 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.)
1 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop" Owner Information
��z
Signature
AOer,k- 414e4Vad
Print or Type Name
(Riparian Property Owner Information)
Signature
Print or Type Name
���4d �z.Lx Doe—

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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date (Pjj5
Name of Property Owner ApplyingforPermit:
/If6 ka4e?�k,& J
Mailing Address:
I certify that I have authorized (agent) //GS ��. to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
611
p r��nr/-a� navnnr Cirtno+.. rn Tio+n

,pplicant: DeY,e,C. K�,Lkv-1 lor-z)ct Permit #: 28 t VJ �� a �} I)
gate: /
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremr
rund in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated f
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
abitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration ar
restoration or
and/or temp
restoration or
temp impact
temp impacts)
imoact amount)
temp imnacts)
amnuntl
r W Dredge ❑ Fill ❑ Both ❑ Othery
■ Complete items 1, 2, and 3. Also complete A. ri!
item 4 if Restricted Delivery is desired. ❑ Agent
■ Print your name and address on the reverse ❑ Addressee
so that we can return the card to you. . Received by ( Printed Name) C. D to of 4livery
■ Attach this card to the back of the mailpiece, 2
or on the front if space permits.
1. Article Addressed to:
Ale,,
« v17
D. Is delivery address different from item 1? ❑ Yei
If YES, enter delivery address below: 0 No
3. Service Type
❑ Certltted Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7 011 1570 O o 0 0 3758 1417
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dredge ❑ Fill ❑
Dredge ❑ Fill ❑ ■ Complete items 1, 2, and 3. Also complete
item 4 If Restricted Delivery Is desired.
■ Print your name and address on the reverse
Dredge ❑ Fill ❑ so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
D d or on the front if space permits.
re ge ❑ Fill ❑
1. Article Addressed to: le
I � rkldl
A. Signature
X ❑
B. Received by ( Printed Name) C. Date
D. Is delivery address different from item 1? ❑
If YES, enter delivery address below: .0
9a'(rJk