59210D - Riley

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_. CAMA / DREDGE & FILL , ao5} iJd
EN ERAL PERMIT Previous permit #
-New Modification Complete Reissue Partial Reissue Date previous permit issued C
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 N U
❑ Rules attached.
nt Name LF V I Project Location: County ?�_tiJt
Street Address/ State Road/
,LO' tt #(s)
State A� ZIPIW// U " f C7/7j�s
#) (n(7 - t `1 Z6"
,,�` Subdivision -fir
ized Agent � OVIIIC+b'i City t�/U� ZIPS
d _ CW fiW PTA _; ES PTS Phone # ( ) River Basin
❑OEA ❑HHF AH = UBA N/A Adj. Wtr. Body oe�"/[,c�aJ (nae
❑ PWS: J FC:
yes / no PNA yes no Crit.Hab. yes / no Closest Maj. Wtr. Body
IF
dock) length Mlown
pier(s)
ONE
1=
,iumber■■■■■■■■��■►\fir■■�'�►�►length
.�Ran
VIA
ivg distance offshore
-nax distance offshore
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■■■ice■■�
channel
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ubic yards
'amp
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Bulldozing
line Length
not sure no
ags: not sure yes no , -
orium: n/a yes no,
s: yes �no LL
r Attached: yes no,
ding permit may be required by:
�...�_ See note on back regarding River Basin

1030 00 23 #0437 P.004/0(
6<J1,AC/
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIEKMOOAEvG PILIIVGsIBOATLLFTBOATHousE)
I hereby certify that I own property adjacent to G� lK� A- "� I
(dame of Property Owner)
property located at
(Lot, Block, Road, etc.)
onT`c�`_.Q ens,\ , in
(Waterbody) (To4n and/or County)
Applicant's phone #:'I��-�i�{',S Mailing Address: cp
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 pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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.)
t"XI do not wish to u°aive
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)
• JJ____
S.EIVE
MAR 2 8 2012
� `_Nl WILMINGTON, NC
(Riparian Property Owner Information)

2012 16: 54 FAX [phone] BSI 191004
t/2030 00:22 90440 P.004/00
e e9C/i vr�/
ADJACENT RIPARU,, PROPERTY OWI ER STATEMENT
(FOR A ,PIE,, IMOORrAG RiLiNGS/BOATLIFT/BOATHO USE
I hereby certify than I own property adjacent to kr
(Name of Property Owner)
Property located at
(Lot, Block, Road, etc.)
LO
on .p __{_I
aterbod
� y) (To n andlor County)
Applicant's phone #:'a `{Di��4�4 5 Mailing Address: ,�
�`
He has described to me, as shAwn.below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back.a minimum distance of fifteen feet (I5`) from my area of riparian access unless
waived by me. (If you Wish to waive the setback, you must initial the appropriate blank
below.))
t/ I do aot wish to waive
I do'wish to waive that setback requircment.
.. ------ _------ --------- ------------------
DESCRIPTION AND/OR DRAWL G OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-
(Information for Property Owner Applying (Ri
for Permit)
l� .,'CFtVED
K R 2 8 2012
1.)i0AINC-l'ON, NC
Owner Info rmation)
Mailing Address
Signature

2012 16:53 FAX [phone] BSI Q 002
;'2030 00:21 40441) P.002i00e
i RECEIVED
MAR 2 6 2012
DCM WILMINGTON, NC

'2012 16:53 FAX [phone] BSI
4/2030 00:22
Q003
90440 P.003/0C
INTRACOASTAI, WATERWAY
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DELORES L. RILEY
DB 3970, PG 295
cL
LOT 3
R8 43, PG 11
PIN: 3292-40-0994-0000
R EIVED
MAR 2 8 2012
�.M', WILMINGTON, NC
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LOCATION MAP
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GERALD EVANS do
PEGGY EVANS
D8 3599. PG 11
LOT 2
PB 48, PG 144
PIN: 3292— 30— 9899— 0000

icant: 1)--7 / /`�-tf, IIK2j1z Permit #: 5—( Z110
tribe 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
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
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 ❑