57361D - Baker

CAMA / i DREDGE & FILL
iENERAL PERMIT
New .Modification ❑Complete Reissue El Partial Reissue
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to ISA NCAC
_ les attached.
Name �' ,y l h� f5, ,�14 Project Location: County FL a'i i ", c/C
State, ZIP I J—ei
(q i �2 _ W /Q/- Fax # ( )
ad Agent rt2 i "C.-
El CW DEW [$PTA DES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes Gam: PNA yes 4no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s) 2 / 62/,�yC &
Subdivision
city zip Z Bylc
Phone # O River Basin
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Closest Maj. Wtr. Body "�'/ " W
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g permit maybe required by: acre" ./ s L Q d 4'��C / ❑ See note on back regarding River Basin ru

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CERTIFIED MAIL RECEIPT
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,..e wr,R,/►�. e•IdN-•� ^a--: �r'" `,••.Nay. r' Certified Fee
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ED (Endorsement Required) Here
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Q (Endorsement Required)
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r- or PO Box l^
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iplete items 1, 2, and 3. Also complete
14 if Restricted Delivery is desired.
t your name and address on the reverse
hat we can return the card to you.
ch this card to the back of the mailpiece,
n the front if space permits.
A. Si ture
Agent
��- Addressee
B. Receive by (Pr me Name) Date of Delivery
le Addressed to:
' 11, �..
rs delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No

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Label/Receipt Number: 7009 1680 0000 2205 9427
Expected Delivery Date: April 28, 2011
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Status: Delivered
Your item was delivered at 10:55 am on April 29, 2011 in GARNER, NC
27529.
Detailed Results:
• Delivered, April 29, 2011, 10:55 am, GARNER, NC 27529
• Notice Left, April 28, 2011, 12:35 pm, GARNER, NC 27529
• Arrival at Unit, April 28, 2011, 9:27 am, GARNER, NC 27529
• Processed through Sort Facility, April 28, 2011, 4:03 am, RALEIGH, NC 27676
• Acceptance, April 27, 2011, 9:10 am, OCEAN ISLE BEACH, NC 28469
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W MAIL
C 'RTIEIED INLU 1. — IZE dJIZY RECELF'T REQl1E;T£_T
DI"VISION OF COASTAL MAXAt' IOAENT
ADJACENT RIPARIAN PROPERTY 0*AYFR STAU.-.NfEN.-T
N ante of Property Owner: t, l (� T r
��ddre ;s of Property: 4 (�i�i'iP iL� r • C;C 4 1@.. i��C'_y�t . �.; r_�''S ' c C' ��-
(Lut or Sareet 9, Stre -�t or Rcsd, Citya- County)
a.rplicat:C's pi ona: ?�` _z __ -? ?74 ivlailing Address: �i_ 1' % i%n!_i
I hereby certf !v that I own property sd';a:ent to :lea above referenced property. -Me iad:vidtial arplying for this pe-rMit
has described to me as shows: on the attached drt:wirg Cite devolarm-ent they are proposing. A descric'ioa of drawing,
with ciirnensions, most be t'rovidA :his le-:er.
_ I have co obi,; - ions to Ws prolvs;,l.
C have objections to this proposal.
If you Lase objections to what is being proposed, yeti rrtust notify the Division of Ceastal ManRgement rDCM
ir. writing within 10 slays of receipt of this nodee. Correspondence should be mailed to 1211 CaHinai Drive Ext.
Wilanington, NC 2840-3$45. DOM representatives can also be Bout-rtex3 st [phone]. No response is
coitsidared the -same as no ab eetion if You have been notified by Certified Mail.
WAIVE SECTION
r undetstand that a.pier, dock:, moorin p lings, T makwater, boathouse, or lift mast be set back a minimum distance or
15' from my area ofriparian access untoss we -wed by tre. (Ifycu kvisit to waive tho setback, you mast initial the
apprapriatz blank below_)
I do wish to waive Cis t5' set back require.-ment.
I do not wisb to waive the 15' set back. requirement.
T erty Owu nformation)
�tgnalvre
Print or Type Name
J �
i�•taii iag Address
City / State I Zip_
Telephon 'Number 843' C-•(P1� - q(ix)t
&-0 OjHr Iafortnati n)
gnai*1 1
6.�i1�Jetj
Print o: Typ Name
T— ✓
Mailing Address
("ity ) State / Zip
Telephone Number

/J Permit #:
)plicant: �, �Pr�Gl � ��/� �/C J (J 1J
ate: te
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurem
fund in vour Habitat code sheet.
DISTURB TYPE
labitat Name I Choose One
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 ❑
Dredge ❑
Fill ❑
Both 0 Other ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
and/or temp
temp impacts)
impact amount)
2 3y
23y
TOTAL Feet
FINAL Fee
(Applied for.
(Anticipated
Disturbance
disturbance.
total includes
Excludes an
any anticipated
restoration a
restoration or
temp impact
temo impacts)
amount)