59296D - Palmatier

CAMA / DREDGE & FILL
_GENERAL PERMIT 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
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
+ ARules attached.
nt ame Project Location: County
YX ►j1'lj (.
s AA rr L, Street Address/ State Road/ Lot #(s)
O(AA_ StateNc ZI�G
# -W. Fax # ( ) Subdivision 9nL y i
ized Agent Subdivision
ra &CY ZIP2-8y
d ❑ CW XEw PTA ❑ ES ❑ PTS Phone # ( ) River Basin Lum
❑ OEA /EI HHF ❑ IH ❑ UBA ❑ N/A nn ,,
ElPWS: ❑FC: Adj. Wtr. Body 1�1 W� (nat
Closest Maj. Wtr. Bo
yes no PNA yes Tn� Crit.Hab. yes no
dy
A Project/ Activity
U 3
(Scale:
lock) length LOx
•m(s)
pier(s)
length
umber
gad/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards
amp
>use/ Boatlift
Bulldozing
ine Length U t
not sure yes no
igs: not sure yes no
)rium: n/a yes no
Attached: yes no

plicant: hv� I r a—� W
Permit
te:6fl
IZ (z
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd 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)
I FINAL Sq, Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anpated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both [I Other
L
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 ❑
- b �/ -� ---' �Sb

9/5/2012 5:55

CFRTMED AJ — RE1URN PXCE _REMSTED
DWISION OF COASTAL NI IANAGEMFNT
ADJACENT RpARIAN pI opkRTy OWM'ZR ST'A 1 i;i�N'T
Nanxa of Property Owner; Vt K--
Address of Property:
66 S - Z- o& k z
(Lot or Street
our-
or,Ro City & County)
Applicant's phony: ##:
"�� O maiiint Address:
I hereby cen1ify that I ownproperty adjacent to the above mferenced praperty. The individual applying for this permit
bus described tome as shown on the attached drawing the development they are pxpposfng. desariotion o drawing,
A
with die ins mcxst be nxvvidod with this fetter,
I have no objections to this proposal _ ___ I have objections to this MPosaL
Jr you Have objections to Vhat is being Irrap0.sed, you must aadfy the Division of Coastal 11+Ialaagement (DCM)
iw writing witluu 10 days of receipt of this notice. CarresPondesm should be mailed to 127 Card'naaI Drive Ext,
NVfiltmington, NC 28405-3845. DCM representatives cm also ice contacted at [phone]. No reuse is
,�t� 3#ciere+d fhe.sarne no ab'ect on if ou have been notified Certified I
WAJWR SECTION
I t[bdcrstand that a pier, clock, mooring pi�iugs, breakwater, boathouse, or lift must be set back a minimum disWce of
15, from my =a of riparian access unless waived by me. (1f you wisb to waive the setback, you must "a' the
appropriate blame below.)
I do ravish to waive the 15' set back roAuiremcut.
I do not wish to waive the 15' set back requirement.
(-6ofmty Owner Ian )
Print or Name
14aiiing Address
VWIaet iLU*JLLAAQ"—J
UM C' Cps liNG s 16-5
Print or Type Name
Mailing Address

"'5V cJ C�c Sysvg VVQJ

%
36f}'D Anc Jackson
J
Leland, NC 28451
)hone Number 910-371-1899
'ax Number 910-371-3290
,ell Number 910-612-3730
=maii [e-mail]
To: Holley Snider
Name`
0c:
Phone:
Fax'
From: Mark Palmatier
pate Sent: 916J12
Number of Pages: 2

CERTIFIED N, ,mL — RETT?RN RECEIPT REAtESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT
TTpRIIPARIAN PROPEKIA' OV "NFR STATEMENT
Name of Property Owner:
Address of Property: 665-- �ack4'..V2
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:
q/# -G/)- —3?3-�,
Mailing Address: '+'a Avx q/S
t /c.t 2, Nc '? a'YS%
I hereby certify that own property adjacent to the above referenced property. The individual applying for this permit
has described to rpe as shown on the attached drawing the development they are proposing. A description of drawing:
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. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contagted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SEMON
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 IS' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Infor )
--
Signature
Print or Type Name
P O &x
Mailing Address
Zc /, 2- rV6 ��45"
City / State zip /
Telephone Number 7 0 — ('J � �30
Date
Property
Si ure
Frint or Type Kame
66 1 t {
ding Address 4+ F c
7 � 5 7
City , tate , Zip
Telephone Number 1 � � `'� a72_
Date 9