59140D - Papagikos

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
-'New Modification ❑Complete Reissue _Partial Reissue Date previous permit issued
prized 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�
J� )4 Rules attached.
nt Name e4lde a/ S Project Location: County /'*+G�
s - t Street Address/ State Road/ Lot #(s)
Nil �9la ft YI StateZIP S Giu7-�
0 (49 /P) LO1,44 /-P ax # ( ) Subdivision
Agent ��t �i7�+�✓/" City 142 !�'�r,'h- �ah _ ZIP_ 2'
zed ent {� IG �' ty e,�
i CW 'y;EW 1 PTA ESI PTS Phone # ( _) River Basin
ElOEA ElHHF ❑ IH UBA ❑ N/A Adj. Wtr. Body
❑ PWS: ❑ FC:
yes / no PNA es / no Crit.Hab. yes / no Closest Maj. Wtr. Body _ "4 Sl' DI'D
if Project/ Activity Ke—c-p n t--1,
s
a■■r�n
6-0■■■■
ad/ Riprap length_
+g distance offshore
iax distance offshore
:hannel
ibic yards
Lmp
Use/ atIR 12 kl y
ne Length ~'*; %p
not sure yes
gs: not sure yes 6)
mum: n/a yes 9`
yes no
Attached: yes tffgl
F1;_Xis / l+
,(Scale: / of
ling permit may be required by: /'% i/ ��%. �/�SL�/Iti S �LjD ❑ See note on back regarding River Basin

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date � 0 1 11
amc of Property Owner Applyiug; fur Permit:
i Cj a_d_A,_ 1)1�0...._ _
Mailing Address,
�o SST i sr
_l _/vz-. o ate----
1 certify tit at 1 havu aitthorized (agent) I' I I\ _ to act on my
bebali*, for the purpose of applying for and obtaining ail C'A N-L-k Pcrutits uccessary to
install or construct Activity?
at (tit%- property- located at) s3� ( 7/* d (Y�
This certification isvitlid (lira (date) 1&� 1 ��
Ile �Ctl ffU � l7atc
JAN

'50A it v v()
�O? X,9 M-1cy(')
3
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CD 3
e items 1, 2, and 3. Also complete A. Signature
Restricted Delivery is desired. ❑Agent
jr name and address on the reverse ❑ Addressee
■ Attach this card to the back of the mailpiece,
So that we Can return the Card tyou. B. Received by ( Printed Name) C. Date of Delivery
or on the front if space permits.
1. Article Addressed to:
(, IV � (AC.O ('LO
L�;;ilry� � r�L _
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
0 Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
z. wncle Number
(Transfer fromservt4 7009 3410 0001 3385 9388
PS Form 3811, February 2004 Domestic Return Receipt
102505-02-M-1540
UrvcW
#I RU-1
aid �1--I ��ir� Nticfl
RECk I VED
JAN 3 0 2012
''CM WILMINGTON, NC

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: _ ff j 4Z 7<q /7--< . AV
Address of Property: 5 3 ,9_5- 1,1v l ,4 � i L). (nn . 16/e a4w'll'�
(Lot or Street #, Street or Road, City & County) // J
/><
Applicant phone #: qjL' �70 "�6 U Mailing Address: -3 a5 /yv %�/
����► ; 't/C yy�i
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 pro osing. A description or drawing with dimensions must be brovided 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.nccoastalmangement.nebcontact 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.
��� I do not wish to waive the 15' setback requirement.
(Prope Ow r I ma ' n
Signature
�rc t ; L4
; %v s
Print or Type Name
�3
R)
Mailing Address
w:1,4 t)--
M/
(Ri
G
Signature
Print or Type Name l
S
Mailing Address
JAN 3.0 2012
ation)
TON

is viwsion oa uoastai m9t. Habitat ;impact Computer Sheet
oplicant: ���,� C�, �Permit
ate:
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
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
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
f
Dredge ❑ Fill ❑ Both ❑ Other
46
Dredge ❑ Fill ❑ Both ❑ Other 11
! t Z
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 ❑