59172D - Silance

:1CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
ONew, ❑Modification El Complete Reissue ❑Partial Reissue
T'7 59
Previous permit #
Date previous permit issued
Wized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resourcg5,Commission in #n area of environmental concern pursuant to 15A NCAC
/{ ❑ ules attached.
it Name Lt- 5 -�( f Project Location: County I rW
r Street Address/ State Road/ Lot #(s)
t fit// //LF State e,ZIP14/r
IE'fQ)3 �Cl Fax # () SubdivisionUlf
zed Agent City P/✓% ZIP
i CW Q EW PTA ElES -iPTS Phone # ver Basin
— OEA 1 HHF XH I-1 URA FN/0
- PWS: ❑FC:
yes / no PNA yes no
,f Project/ Activity
JAU Q (
)ck) length V x sO,
n(s) /D fX /Z/
)ier(s)
.ngth
ember
id/ Riprap length
g distance offshore
ax distance offshore
ie Length ;*:& / r.;
Adj. Wtr. Body
Closest Maj. Wtr. Body
in permit may be required b : 3 J 0 H% f - �1� ws V �— e — ` � —
g P Y 9 Y See note on back regarding River Basin r

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner:
Address of Property:
Applicant phone #:
Dsq W rid6an J41'Vf-)1ShPadS kflU4A1Co ASID)
(Lot or Street #, Street or Road, City & County)
Mailing Address: 19 9 bo fe(,(yle' C�I�
\IQr k:5DX0iL — /& aKakQ
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 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.
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.net/contact 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 wis h to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
� 41 rn" &10-V) (L"
Print or Type Name
1 v LF..ju ire 11 v&
Mailing Address'
Riparian Property Owner Informatiop)
Signature
o 0---
Print
or Type Name
Mailing Address

/29/2012 11:14 9103271433 COASTALMINISTORAGE PAGE 01
COASTAL DREDGING
2075 HWY 172 / PO BOX 295 PHONE [phone]
SNEADS FERRY, NC 28460 FAX [phone]
FAX MESSAGE COVER SHEET
DATE r
PAGES _ INCLUDING COVER SHEET
ATTENTION _ l COMPANY
FROM
StBJECT
t mo , i i
FAX 9 a D 395_- _3

Onslow County, NC - GoMaps
Page 1 of

/29/2012 11:14
9103271433
COASTALMINISTORAGE
PAGE 03
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Ram 4 ff PAWAd ad Daivery Is desired.
• Print your name and address on the reverse
on that we can r1hun the card to you.
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or on the front if apace porn, &
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V 29/2012 11:14 9103271433 COASTALMINISTOP,AGE PAGE 04
■ CompNrbs Rams 1, Z and 3. Also oompim
hm 14 Raetrictad Delivery is dashed.
■ Print your name and address on the reverse
80 VW we Can rahwn the card to you.
■ Attach thla card to the Dwck of the mallpleco,
or on the fwn M space permits.
1. Mae Addressed to: ----- --
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P8 Form 3811. Femrtl vy 2ow Damwdo Ream -
CERTIFIED MAIL, . RECEIPT
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'N

pplicarit:
ate:
Permit
/ , �
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen,
and in your Habitat code sheet.
DISTURB TYPE
►bitat Name 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 FINAL Feet
(Applied for. (Anticipated fina
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/c
restoration or temp impact
temp impacts) amount)
D
Dredge El ❑ Both El
12-/
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 0 Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to "lf}-j�1E� S/ L 4NGE s
(Name of Property Owner)
property located at ����% %herl, /14/I
(Lot, Block, Road, etc.)
on inN.C.
(Waterbody) (Town and/or unty)
Applicant's phone # q3�y Mailing Address: 1707 /,4t i- P.
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 �5 rfR �' mt— �� r, 0
Z127 I do wish to waive that setback requirement. I-S-114
----------------------------------------------------------------------------------------------------------------- I
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVE PMENT:
(To be filled in by individual proposing development) %%
l
/;Om // ;4 / _
I
(Information for Property Owner Applying
for Permit)
Mailing Address
-------------------------------------------------
(Riparian Property Owner Information)
Signature