60631D - Palmtier

} :AMA / ❑ DREDGE & FILL / NO. 6a
GENERAL PERMIT Previous permit#
IN New ❑Modification (Complete Reissue -]Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources �} �' . I It,
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC —{'�
A� tt Rules attached.
nt Name yJ"t aek ��( `mA-1� ty Project Location: County �VV h-W 1L.
s V. C 1' • 1 Street Address/ State Road/ Lot #(s)
State ZIP -4451 G&5 L(,C� WLOd gllk, '�•
Fax # () Subdivision N/A
zed Agbnt City YNIV►d� ZIP
CW �KEW PTA ❑ES ❑PTS Phone # (. )�1tiU River BasinUro
- OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
_ Adj. Wtr. Body W w (nat
/PwS: (no
yes no PNA yes � Crit.Hab. yes / no Closest Maj. Wtr. Body
)f Project/ Activity 1L :1-k—l" (A ff. V,
:hannel
jbic yards
imp
use/ Boatlift
3ulldozing
-ie Length V u
not sure yes
gs: s: not su yes
m: n/a
Attached: yes
(Scale: 1 / M
ing permit may be required by:
❑ See note on back regarding River Basin

ove
EV

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CERTIFIED MAIL — RETURN RECEIPT RE UESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: A g
Address of Property: �(yS DC. I (� c %
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:
q 1. - e i '? 3-)3 `) Mailing Address: Q ,x
i �5
e /4',1, N•c .2_?yS/
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 descrition of drawing.
with dimensions must be pxovided with this letter. ,
o objections to this proposal. I have objections to this proposal.
I haven o J
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCK
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 contacted at [phone]. No response is
considered the:same as no ob'ection if you have been notified b Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set backa minimum distaninitial ce of
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you
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 Owner Information)
Signature
Print or Type Name
Mailing Address
/ - /,_ ) Air_
(Ripar• P perty Owner Information)
"S
Si afore
Y ✓! . �R < L 1 NG.�
rint or Type Name
,Ya 3 � C 2 -0-M
Mailing Address ,�

-r -raI— V
i 17--
L �,9

P t L.--
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: 041
Address of Property: _ (: & 9 0C (Zj , VL 1: o r, t � n5:-=• �t�
(Lot or Street #, Street or Road, City & Coamy)
Applicant's phone ##: � 0 " r 3.) L3 Mailing Address: r �~ V z, X � C� ! 1
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 devel=ctions
sing. A description of drawing.
with dimensions must be provided with this letter.
I have no objections to this proposal. 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 contacted at [phone]. No response is
considered the same as no vbiection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, break -water, boathouse, or lift must be set back a minimum distance of
1 S' from my area of riparian access unless waived by me. (If you wish to waive the setback,
l��
appropriate blank below.) DCM WILMINGTON, NC
I do wish to waive the 1S' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Siena re
Print or Type Name
?, �& �x � 19
Mailing Address
L e % 2 .;,arc_ ?
City / State / Zip
Telephone Number % `' ' � 3 2 30
AUG 1 0 2012
Information)
. } ,Tt 1 Q 0c
Print or Type Name
�70iD4 t1
Mailing Address
City i tate Zip +
Telephone Number 1C� l — � ; • t " `�%

��d
C-7

,pplicant: V w at (- I�
Permit #:
gate:
q1til �z
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
,und in your Habitat code sheet.
ibitat Name DISTURB TYPE
Choose One
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 ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
and/or temp
temp impacts)
impact amount)
�O
(0 O
ado
Gc��
TOTAL Feet
I FINAL Feet
(Applied for.
(Anticipated final
Disturbance
disturbance.
total includes
Excludes any
any anticipated
restoration and/or
I
restoration or
temp impact
temp impacts)
amount)
< 1 Arn x 1 - ( - n