59134D - Ward

CAMA / DREDGE & FILLS
GENERAL PERMIT Previous permit #
New —Modification ❑Complete Reissue Partial Reissue Date previous permit issued
oriized 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
' ,,,,jj Rules attached.
nt Name Project Location: County`SbJI(,1L
s I 1 YY1D6 V f, Street Address/ State Road/ Lot #(s)
,. 1'\ State ZIP a�5,2.
# ( nq `` I Fax # ( ) Subdivision A
ized Agent City CIA (lU, ZIPS
d CW r;L7AEW A PTA ❑ ES PTS Phone # l ) 514 D- 5 River Basin -=
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body nat
yes PNA yes j / no Crit.Hab. no Closest Maj. Wtr. Body
yes (no) I wVV
A Project/
lock) length
m(s)
pier(s)
length
umber
!ad/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards
amp
)use/ Boatlift 3 x
Bulldozing
I
ine Length
not sure yes no
igs: not sure yes no
)rium: CLa no
s no
Attached: yes.o
ling permit may be required by:
(Scale:
s
El See note on/back regarding River Basin
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tACAT10M OF PROJECT:
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
lame of Property Owner: ?-11OKKI l.)atif
kddress of Property: 1 �� L V Vln, &AWtoi.- S t ,
(Lot or Street #, Street or Road, City & County)
kpplicant's phone #:
Mailing Address: [!I Aab—t Z),-
�ti�'rtcf�,
hereby certify that I own property adjacent to the above referenced property. The individual applying for this pi
ias described to me as shown on the attached drawing the development they are proposing. A description of drat
Nith dimensione must be provided with this letter.
�z 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 (D(
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTI0
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distan,
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. b, w rs' �• ` 10
I do not wish to waive the 15' set back requireme k 1. P W0
(Property Owner Information)
Signature
.2o rkyl WOW
Print or Type Name
_ 11 / a ,D,-j ite
Mailing Address
'f' (Rip rian Propeity Owner Information)
ign t e
'<::J�4tvl
Print or Type Name
/%5oy Cove 1/CecJ C-�-
Mailing Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: "�0Y\,YL*,%f— WO\,rL
Address of Property: L v .n��j.ai' z-- S 4
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:
Mailing Address: & ZA/4 kC'm ;A--
t� �M c •. 5.(, z 4S"3 Z
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this F
has described to me as shown on the attached drawing the development they are proposing. A description of dra
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 (D1
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Driv
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response
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 distal
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial th
appropriate blank below.) Goy
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement. ys
011 p `I
(Property Owner Information) (Ripar' Property Owner Information)
?0AV%i `Q, Luck I G
/"
Signature ignature
Print or Type Name
Drive -
Mailing Address
rint or Type 14ame
Mailing Address
t

ilicant: ,n t Q �� ►�
OVA 1.
3 1� )�
Permit #:� 13�
,ribe 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
tempimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge El Fill ❑ Both ElOther)( .
Nil
� v/
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 ❑