59188D - Teibel

L1'-CAMA / i DREDGE & FILL 59
GENERAL PERMIT Previous permit # N
qNe v-, ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued 4
)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 7
❑ Rules attached.
it Name m /%C T I Project Location: County �ENDgx-
o _ State_t ZIP
zed Agent
I CW EW PTA ❑ ES ❑ PTS
OEA HHF ❑ IH UBA ❑ N/A
PWS: ❑ FC:
e ,s no PNA yes Cn> Crit.Hab. yes no
�ngth
ember
id/ Riprap length
g distance offshore HL
_
ax distance offshore
hannel
i
ibic yards
mp
y
u oatli
- - I
Su Idozin
a S S vo
ie Length /
i
not sure es no
s: not sure yes
rium: n/a yes
Attached: y n L
ing permit may be required
Street Address/ State Road/ Lot #(s)
ZO s� f/s I -I t �/ 600y
Subdivision
City A /1,M'4166 U/U ZIP-7 k4
Phone # ( --j— River Basin CZA
Adj. Wtr. Body (na
Closest Maj. Wtr. Body ��S%y� SoyND
y: , 1�/t/g57 ❑ See note on back regarding River Basin i

16'x 16' I I I
0 0
Gazebo
CW Setback (80') ICW Width = 603'
x
Pier -head Floating 30" Water
,
Line _ •Dock Depth @ MLV
. -10'
M.
127'
Marsh Line �
0
12'x 12'
• - � - Boat Lift
8' x 10'
Jet Dock
Aluminum
Ramp
4 'x 9'
Gang Plank
1.1.1.1=1=1=1.1:1-1111:1.11.1-11111.1 1 1 1-1 1'1 1"1
1
1
R/C

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner. rA 4(--.�, - .3 `- 3 {. L j \- 2, i
Address of Property: k , \ l
(Lot or Street #, Street or Road, City & County)
Applicant's phone #k: 9 "q- Z ? - o Mailing Address:
� r �
1' 7, r
21,
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permi
has described to me as shown on the attached drawing the development they are proposing. A description of 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 (DC A)
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 obiection 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 (Riparian Property Owner Information)
77
Signature
r'j,�-�c:�, \ -:.,�--- L
Print or Type Name
Signature
Print or Type Name
Mailing Address
AA
Mailing Address

A -14--
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: rJ P 1
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: 9 �c�—I:.,
Mailing Address: S
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 of 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. 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 mast 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.
wroperty Vwner Infoi
Signature
Print or Type Name
(Riparian Property Owner Information)
Signature
h.
Print or Type Name
Mailing Address
Mailing Address

P
1plicant:7 4zf Permit #:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind 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.
bitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/o
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
SSr~. ¢S \v y �bk
Sc-e-\kS Q"11 \'.� O.►7.
't
11
A. Signature
X 131 _ ❑ Agent
dressee
B. Received by Printed Na ) C. Date of Delivery
T,A/•/i
D. Is delivery adfiress d" from item 17 ❑ Yes
If YES, enter delivery address below: _k*`NNo
3. ce Type
Cedtfled Mail ❑ Express Mail
❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2, Article Number
Mransferfrom sere 7011 1570 0000 5124 0550 -
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 If Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
i or on the front If space permits.
X Si�
A,
JC14T.ressee
B. Received by (Printed Name) C. Date of Delivery
1. Article Addressed to:
31 t?e--A `PR ��o�n fv S a^
D. Is delivery address different from item 1? rYes
If YES, enter delivery address below: — \No