59177D - Rahman

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
- New New Modification ❑Complete Reissue CPartial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources ' I
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
�//
� • Rules attached.
nt Name V& 1"..t-
VA0 K" Project Location: County TXVY15W I0c.
s y ! ( 1 `' (Irk 1 Street Address/ State Road/ Lot #(s)
C
L ►1 A t m State NZ ZIP Z I /,� o OL I STY. -C }`
# ( ) -1ki- bl5V� Fax # ( ) Subdivision
izedAgent 1 �`iW L,LriSWL4ini� ity� Y1�SC% C3fLtI�G ZIP
.d L CW EW PTA ❑ ES PTS h e #) 0 1 a(er Basin
1. OEA HHF _ IH ❑ UBA C N/A Adj. Wtr. Body k4 A 111� - TUbin (nat
C PWS: ❑FC:
yes f no PNA yes /(1 0 Crit.Hab. yesOno Closest Maj. Wtr. Body 1 wW
of Project/ Activity ); Y"( -
U (Scale:
Jock)
rm(s) b x ►U
pier(s)
length
lumber
gad/ Riprap length
ivg distance offshor
nax distance offsho
channel
:ubic yards
amp
Ouse/ Boatlift
Bulldozing_
ine Length __
not sure
igs: not sure
orium: n/a
s:
r Attached:
ding permit may
- .... --I-11 171\n & - A All 11.1 /t-I. I..A (.1. .1 .,, I _L_ . -_ 1

RC ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee FreE
Beverly Eaves Perdue James H. Gregson Secr
Governor
Director
AGENT AUTHORIZATION FORM
Date: -2
Jame of Property Owner Applying for Permit:
Owner's Mailing Address:
yiY % —
Phone Number (33(,l � G � U�'G 3
Name of Authorized Agent for this project:
Agent's Mailing Address:
Phone Number
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
install or construct the following (activity):
for and obtaining all CAMA Permits necessary to
V C PZ_/4 c� st -/, 06-_C K ©C ____
(my property located) at
This'certification is v (date)
Ni /Mc N �2?,
Date
2012

iAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to
1► l 6n(A Cl\1rnc l h I
(Name of Property Owner)
property located at -�� CQv-\0.�
(Lot, Block, Road, etc.)
on , in _� z�p� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #8 0(4(::) Mailing Address:
WLI
�P' ( Z7�
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.)
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)
�Qb
Mailing Address
(Riparian Property Owner Inform ion)
Signature

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Jame of Property Owner: MN \Qo
address of Property: )�
'applicant's phone #: '11��'q(Yk�)`
Street #, Street or Road!City & County)
Mailing Address: ba •C�
Cn_1e 'C�eCKY,\ NC Z__ 'O`l
i hereby certify that l own property adjacent to the above reterenced property. The individual applying for this permit
.las described to me as shown on the attached drawing the development they are proposing. A description of drawing,
,vith dimensions, must be provided with this letter.
✓r 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 contacted at [phone]. 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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Print or Type Name
Mailing Address
Print or Type Name
-P, D .-Bawl
Mailing Address

Or
C4
.ter

�
licant: / C ou" I K'a- h
I-V 1 &- V\
Permit #: -C-,,—,l J --�--7- T)
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3ribe below the HABITAT disturbances for the application. All values should match the name, and units of
measurement
id in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for-
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
tat Name
Choose One
includes any
Excludes any
total includes
any anticipated
Excludes any
restoration and/or
anticipated
restoration
restoration or
and/or temp
restoration or
temp impact
#o,.,., i--fcl
imnant amount)
temp impacts)
amount)
3 Dredge ❑ Fill ❑ Both ❑ Other] (y
nplete items 1, 2, and 3. Also complete
n 4 If Restricted Delivery Is desired.
it your name and address on the reverse
that we can return the card to you.
ach this card to the back of the mailpiece,
)n the front If space permits.
;le Addressed to:
o �x V5%
�4c 2!1S'r
A. Signature
x � Alpt
❑ Addressee
B. Received by ( Printed Name) li e C. Date of De
D. Is delivery address different from item ? ' ❑ Yes
If YES, enter delivery address belo : ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ;MBetum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
;le Number
osferfromservice/at 7009 1680 0000 2205 9571
rm 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both El Other Elr
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For delivery information
visit our website
at WWW.usps.com,.,
Dredge Fill ❑ Both ❑ Other El
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Postage $
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Dredge ❑ Fill ❑ Both ❑ Other ❑
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Certified Fee
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Return Receipt F ee
(Endorsement Required)
Postmark
MAR �� 2012
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32
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Restricted Delivery Fee
(Endorsement Required)
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