57311D - Barker

CAMA / DREDGE & FILL
;ENERAL 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 j
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 21Z/ , 111�"�
[ iMes attached.
t Name Z,�,y %p -�
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Fax #( )
ed Agent
❑ CW r] EW [-PTA DES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
es / o PA yes / C 't Hab
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Project Location: County �2N r S �✓� ��
Street Address/ State Road/ Lot #(s) 7 00 L�D
Subdivision
. yes
City ,45� /I ZIP Z �
Phone # ( ) River Basin
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ig permit may be required by: ❑ See note on back regarding River Basin rL
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property: y�� ��+� J t)054 OPg!) NC gqy q(j
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The individt
applying for this permit has described to me as shown on the attached drawing the development th
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
J P P
If you have objections to what is being proposed, please write the Division of Coast
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-391
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift'Must be s
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If y(
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Sign Name
AJ4/20)1
Date
C - Q • _T n0 iwasoA/
AVE"Iff-WA

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
I F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secre
Authorized Agent Consent Agreement
�JC41 r / Yj is hereby authorized to act on my behalf
(Printed Name of Agent)
to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to th
activities described in the attached sketch.
'ION OF PROJECT:
_-lU�h 5j. SunsP-f &,qch
RTY OWNER MAILING ADDRESS:
z 5 Prr`✓`'�4'�ti �✓Q-ri vQ
PHONE NO.
RIZED AGENT MAILING ADDRESS:
/ A)a6Aar E VC k :i-5 �A �(f
,1 IM aY2
PHONE O.
e of PropertyOwner:

plicant:ile: 51-VII
Permit #: r � --?/ /
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
Ind in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fin
�itat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
/
W
Dredge ❑ Fill ❑ Both ❑ Other
;14-,2
2 2Z
Dredge ❑ Fill ❑ Both ❑ Other
plete items 1, 2, and 3. Also complete
4 if Restricted Delivery is desired.
your name and address on the reverse
at we can return the card to you.
h this card to the back of the mailpiece,
the front if space permits.
1 Addressed to:
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Ca 1m-YL M '
t,k2, oho 4gIy5
A. Sipre
X ❑Agent
❑ Addressee
B. ReC. Date of Delivery
/ 4--0-//
D. Is delivery address differen*rom item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
Number
or from service label) l
Cbroary2(iOQ— mac= mestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete A Si
item 4 if Restricted Delivery is desired. X ❑ Agent Print your name and address on the reverse ❑ Addressee
so that we can return the card to you. B. Received by (Printed Name) C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1? ❑ Yes
Phinv D v� If YES, enter delivery address below: ❑ No
L Lr � 4
KGIC S!:7 "COA0AAA Eh.r,�

►OCKS & BULKHEADS INC
MONSTER BUCK ESTATES
SUPPLY, NC 28462
910-755-6861
DATE
ING AND TRUST COMPANY
ANK BST BBT.eom
D�-
)0063 21 nm 1:0531011 21i:0005 21579 2137
6326
66-112/531
$ 00 00
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COLLARS u , _ �^
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