59231D - River

V CAMA / DREDGE & FILL `
GENERAL PERMIT Previous permit #
❑New ..Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
orizdd 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
1 Rule/s attached.
nt Name �-jyo re 1S tr rd � i7 Project Location: County Ale Av
025 Street Address/ State Road/ Lot #(s) 1�!
�iY'1 /vt�t/fire State�L ZIPei,
# ('Fle)2~6�� Fax # ( ) ''""� Subdivision �-%✓� ✓ �S�
ized AgentCity ti(// b'1t/�� A" ZIP 2�
,d _ CW _ EW PTA ❑ ES PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA L] N/A
I:
❑ PWS: ❑ FC:
yes /eo
of Project/ Activity
i
ous tlift 12 X 14
ine Length
not sure yes V
ags: not sure yes Aro/
orium: n/a yes
s: Y'es; nnoo
r Attached: yes ( / ding permit may be required by: 4Z11 (-C). �I�S�I�%/Ciri►� �r/- ❑ See note on back regarding River Basin
�___._, 7) /_, �u ._ _
Phone # ( ) "�^ River Basin
Adj. Wtr. Body C_ '4 ! �P6t/ na
Closest Maj. Wtr. Body �' �� ����

/,
PAr
NCDENR
North Carclina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
Dee Freeman
Secretary
AGENT AUTHORIZATION FORM
Date: 'A - y- I
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Owner's Mailing Address:
Phone Number Iu) 2"t9-3aol
Agent's Mailing Address:
1� i \� W y(�A upe, ffla ul ('unT
�«a � ►dn�t t'.
��1m,rrah-A
Phone Number ((10)(�-n�
I certify that I have authorized the agent listed above to act on my behalf; for the purpose of applying
for and obtaining all CAMA Permits necessary to
t1 install or construct the following (activity):
(my property located) at l 1't �rv��na+fin._ IBC 28'LIZ
This certification is valid thru (date) �n - 2 -i - 12
IqL-Z-- `I - ZLA. t2.
Property Owner Signature Date
E EIVED
APR 2 4 2012

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to :;�'uer 1slaan IV0A £a.seinene
(Name of Property Owner)
property located at The ewee 2 3 � 1 Z S CA) o
r (Lot, Block, Road" etc.)
on �ra o� l�e r�2 ���/riZ , in ►,) nl , N.C.
(Waterbody) (Town an'/or County)
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
jV_ I do wish to waive that setback requirement.
----------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
. e e cn-i ac. GJ fo`w L
-----------------------------------------------------------
(Information for Property Owner/Applicant
Applying for permit)
123 :2�sIQJ —&Ju 1.)a 4
Mailing Address
City/State/Zip
R E ( .,. �- I'll 01
APR 2 4 2012
0C:M WILMINGTON, NC
----------------------------------------------------------------
(Riparian Property Owner Information)
I
S(Iature
Print or Type Name
00. R,1,J I [,-,-) �7
0 1 /1 . 7 -74 ? c3 i

tj
10
ri
Ev
C� 10
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C14
uLL.
j ,.L4

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to
property located at
iuer 1.5124n A0.Seff7enC
(Name of Property Owner)
3 � IZS I-S)a4a--;dcie W0.0
r (Lot, Block, Roac', etc.) v
on Ca oe_ r e �`t U ciZ , in Al ff Lj gAnlo yeA C, .- to , N.0
(Waterbody) (Town an'/or County)
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.)
NI do not wish to waive
1U A. I do wish to waive that setback requirement.
S�e-1 e
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
G-"aC'�0) ( Af0.c%1v.s
---------------------------------------------------------
(Information for Property Owner/Applicant
Applying for permit)
2:7-s /a No � d a e (J a �t
Ma
iling Address
lV 2g �f Z
City/State/Zip
RECEIVED
APR 2 4 2012
`ACM WILMINGTON, NC
(Riparian Property Owner Information)
Signature
�/ G
;
Print or Type Name
r? i /-� . 7 -70 -,� r+, i

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�licr%nt'
Permit #: S—�7 2,3 /
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
iitat 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)
' ^ /
Dv "
Dredge ❑ Fill ❑ Both ❑ Other
/49
//8
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 ❑