59116D - Price

. CAMA / DREDGE & FILL
,E N E RAL PERMIT
Previous permit #
-,New ❑Modification - Complete Reissue JPartial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and
Natural Resources L i1 , j
�T 1H
Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC . zc o
it Name , it 1A ,• j. i , . f►��� (E
v Rules attached.
Project Location: County �� V V i 1 Sl V 1 C iL
i (. l�t� I ►1t(' (� j Y (� f
Street Address/ State Road/ Lot #(s)
A,\ I rY State_ ZIP Z
i J G i'CLI I�
(-"Lfs)Z1��,-�I Fax
Subdivision
ized Agent 1ry), ��1, Vti'VV
City o ZIP
f , CW EW PTA ES - PTS
d
Phone# 4LIU5 River Basin LUI'V
OEA HHF C IH UBA �- N/A
n
Adj. Wtr. Body Oct i-10 � (nat
PWS: El FC:
yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body ' 1v `�
I I
Df Project/ Activity O �1S itw C b'I t v (l u L k I
(Scale:
�i
lock) length 1 x e
•m(s)
X
pier(s)
length
camber
aad/ Riprap length_
vg distance offshore
nax distance offshore
channel
ubic yards
amp
case/ Boatlift
ine Length
not sure
Igs: not sure
>rium: n/a
Jing permit may be required b1y': - (I F'y ) i' +(',j �, u ❑ See note on back regarding River Basin
i c_,._:_I �__�:�:--- I / t',A it 1A A A i I I ,44 t L .i ii`, /i 1, l-:^n fi A ,,. A Ce l • . — { , „a, . , i, L - r -

Bevedy Eaves Perdue
Governor
WAM J AN 0) 3, 2,
HCDM
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
James H. Gregson Dee Frei
AGENT AUTHORIZATION FORM
Date: 8 -31—!�
Xof P Owner Applying for Permit Name of Authorized Agent for this project
k� )q R/7l e G �J J S
owner's Mailing Address_
4i0 3,YeVYLqr-f-f Grac k
I NUAWISDUVAMI,
hone Number (34) ZlS= f %$4 Phone Number (916 ) 23 3 (0 OS
certify that i have authorized the agent listed above to act on my behalf, for the purpose of applying
it and obtaining all "JA Permits necessary to install or construct the following (activity).
ny_ Prvperiy located) at /32
S
his certifica...14tion is valid ru (date) �1yq �, 201 Z
$-3/-//
Property Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY Fi2l
WNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. Robea-+ � C.6
Address of Property.
Applicant phone #
Lets s! �` sZ ��%f9y S-f r,ff go
(Lot or Street #, Street or Rodd, City &
Mafling Address:'q'WALiW�ife clse f
111d, foie Ille ,7
I hereby certify that I own property adjacent to the above referenced property. The individual
y
for this permit has described to me as shown on the attached drawing_the development
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.
ve 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.nccoastaimangement.net/contact dcm.htm or by calling 1-8884RCOAST. 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 15e set ack, you must initial theappropriate blank below.)
Vvt I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Pro y wren Inf ation)
'ignature
Print or Type Name
Mailing Addy Bess
i> 1 > 1
(Riparian Property Owner Information)
/- 11 n
Sipf alure ` — I
�i*MY V - llrloq�e>Y
Print or Type Name
'-&2z'9
Marling Address

DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFiCATIONjWANER FORM
Name of Property Owner_ R)6+ jq Fp_I Cf,
Addis of Property: t atS J—I F'52 Ankf h sf y't %d Ovw RmJ4 N C zo
(Ld or Street #, Street or ftA OV
Appkrrtphoned: 33b 2!s-V0J/ Mailing:'tf1V,ayfu/,+�1i //arc
g Ak' z745
I hereby caertify that I own property affpcent th the above rek enced property. The individual
applying for this permit tm described tD me as shown on the atxadied drawn c -the devebpffmni
they are pn*osk*ig- A deggiistion or drawir & with d mensions. must be provided wM this kOw-
I have no objections to fhis proposal_ I gave ob*;ficns Io this pnoposal.
Ifyou heave objections JD mtWis being proposed you mustnoffy the Dividon ofCoasWURnfigammud
(DCAQ in writing wig! 10 days of reesW of V&b nodm Contwt hifurmasO ! for DCX offiDw is
avadeble at www _dcm hebn or by c- m9 1-M-1R'COAST. No
response is conskbred the same as no objection 0 your have been noel W by CerOW b/a&
I understand that a per. dock mooring pings. brealumater, boaftuse, or lift must be set back a
mirikmm distanoe of 15' from my area of r4mrian access unless waived by me. (if you wish to
waive =.1
you must initial the appmpriate blank below.)
o wish to waive the 15' seRm * mq*m mnt- DEC 16 2011
I do rotwsh to waive the 15' setback regWmn*rrt �,pf,kflNGTON. NC
igratrrre
Print of Type Name
, a Ai v;j //fit L/►�C/`�
Property Owner Information)
PnF*orType Name

ADJACENT RIPARMN PROPERTY OWNER STATEVII
(FOR A PIERIMOORVVG PIL17VGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to
property located at
(Name of Property
(Lot, Bloc� Road, etc.)
Lars sl 1 SL
r
"o G
on CANAL C in
Noes e&yH BRV&SM" co , N.c.
(Waterbody) (f'own andfor County)
Applicant's phone #:
336 �i 5 - 978 `( marling Address: 410 B uR-q..*, V ee Ci 0af
fit&" A*,AT- tX 27245
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal I understand that a pie rimooring pilings / boatlift / boathouse
must be set back a min mina distance of fifteen feet Q 5`j from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
IQ W , I do not wish to waive
I do wish to waive that setback requirement_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
4 to B yrwt� itEE GecLe
Mailing Address
DEC 16 2011
,', %. P'v'1 y 11 _ ' r" " i� •+ i'!'I �1 ,. NC -
(Riparian Property Owner Information)
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Division of Coastal Mgt. Habitat Impact Computer Sheet
licant: R'b"4-A, Py1-Lk- Permit #:
5
-ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
tat 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
(Anticipates final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
—k-.
Dredge ❑ Fill ❑ Both ❑ Other
l �g
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 ❑
1 �XI �3�4

GARY GURG
LAND
SUPP 1108 SWORD D S-r SURVEYING
LY, NORTH CARD I A 28462
FAY TO THE [phone]
ORDER OF
FIRST BA s,Toi NK
MEMO da� OAROLINA 28470 ' �I
66-456-531
1 1448
DATE
$ Oz. ao
#•O 5 3 104 568i; 0 ? -
1 0021333
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