56654D - Crosby

CAMA / DREDGE & FILL
"ENERAL PERMIT Previous permit#
'New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the state of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
r7 Ruloc .".A—i
t Name � in S ,� ; C-f L. t f i k_-
1 ? q j-aI ( kd ---
`Va n�6 e id State ZIP
(-`h } fI-�2^,—Fax#( )
ed Agent i �Y.� ,✓! rCt�r rC -
❑ CW LtEW BVTA ES PTS
❑ OEA ❑ HHF ❑ IH UBA N/A
❑ PWS: ❑FC:
yes / PNA yes / no Crit.Hab. yes / no
Project Location: County e 1 a tl r�jx /r (_ is
Street Address/ State Road/ Lot #(s)
/' 1�J� 6-
Subdivision /3e,46,1-
CityZIP o?rS�i
Phone # (70 ) 3b I - _3 2 S,�- River Basin
Adj. Wtr. Body CO--, -oJ Off A 4JAJ (n
Closest Maj. Wtr. Body A 61 Al
' Project/ Activity Aau ��a,4- r l,�s /- c6t,,- PY J,s r�2
Sri✓ , e— D, e.., / l_✓OC (Scale:
ck) IenQth toY/'S 41AA
■■■■■■■■■■■■■MEN
■■■■■■■■■■■■■■■■■■
■■■■■■■■MEMO
MEMO
■■■■ON■■■NN■■■■■■■
MMEMEMOMEMIrEMEN
■■■ilRNIMEM■■■MMEW
ilr■r■■■■■■■■■■■■■■■■
■O■■N■MO■■■OM■■■N■M■EM■M■MNNM■NONE
.. .
■N■■■■N■■N■■■■■■N■■N
M■■NN■■MNMME
■■■■■■■■■■O■■■■■■■■■■■�■■■■N■■■■■■N■
■■■■■■■■N■N/!MENEM�,Si■■■■■■■■■■
■■■■M■
■
ILE
ONE
M
■,DER■
ww—wwOON■
I
■■■■i■■■■■■
■
■■M■N■■W■■a1■WOOM&
NM■■N■MM■■MM■■M■■
■O■■■■■!!E!■K�ii
■1
i�llllllll�l�i■Ni
■NNE■■■■■■■■
■ME
M■M■n■■■■Owl■1�■u'i■■■■■■■■■■■■■■■■■
NOON
■NM
fL�l■!
1!�■■■I.
NOONIMINo
NNN
LION■iIMINTdOK.AIMENMMM■■■
MN■MMNNn■■■■ONMINWIM
Fi■?OO■■■■■N■■■■■■
■■■■■■■U■■■■■■t�N►ley/■■
■�■■■■■N■■■■■■
■■■■■N■u■■■■■■■■ram/■■
■■■■■■■■■■■■■■■
- .
NOON■■■u■■■■■■■■►��■�N■■■■■■�■■■■■■��
�E■Min■■■■■■■iNN■■■�■M■■a■■■■!�■■■■■■
Ig permit may be required by: ! 'O�C t,5e,4CJ ❑ See note on back regarding River Basin ru

CERTIFIED MAIL—RE"TURY RECEIPT REQUESTED
DIVISION OF COASTAL NIAtiAGEME3�tT
ADJACENT RIPA,RXAA:N PROPERTY OWNER STATEL MENT
Name of Property Owner. —
Address of Property.
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:2Z',I,, Mailing Address. ---�a -2 G,�Il i
I hereby certify that I own property adjacent to the above referenced property. The individual applying lvr uns pcn,iik'
has described to me as shown on the attached drawing the development they are proposing. A descrimion of drawing
with dimensip6s, must be vrovided with this letter.
a~ --I_ 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 hays of receipt of this notice. Correspondence should be mailed to 1127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCiA representatives can skbo be contacted at [phone]. No response is
considered the same as sro obeecioon if oat have been notified by Certified Mail_
WAIVER SECITON
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
a`ropriate blank below,)
I do wish to waive the 15' set back requirement.
I do not wish to waive the IS' set back requirement.
(Property Owner Information)
F
ignature ��
Print or Type Name '
V i - 1-
Mailing Address
(Riparian Property Owner Information)
'" x-X
Signature
Print or Type Name
Mailing Address

CERTIFIED MAIL — RETMJN RECEIPT REQ(JESTED
DIVISION`- OF COASTAL-MANVAGENNIV`T
ADJACENT RIPARIAIN PROPERTY O'%?gER STATEMENT
Name of Property Owner. _ T.,�} ylr � f ef:" /
Address of Property: ZA�
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: %D&--7ZJ 3,26'2-Mailing Address: Y--?- 7 �/ /Z
I hereby certify that I own property adjacent to die above referenced property. The individual applying for uus pGnu
has described to me as shown on the attached drawing the development they are proposing. A description of drawing
with dimens' s must be rovided with this letter.
kv
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 Ex
Wilmington, NYC 284OS-3845_ DCM representatives can also be contacted at [phone]. No response is
eonsidered the same as no obfe won if you have been notified by Certified iYtail.
WAIVER SEMONI
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance o
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you most initial the
appropriate blank below.)
F do wish to waive the IS' set back requirement
I do not wish to waive the IS' set back requirement
(Property Owner Information)
/ -posture
Print or Type Name
,V �y AA ,e I'% ll 12a:
Mailing Address
'pariast Property Owner luforma .ou)
Si ature
Ir Ir, od
t or Type Name

)osed Boatlif t
xisting Dock
P. L

A-/ A. -
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: 4?z 4:2:/Z r—z- �-' S DSO Si
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:�Oy 3�� _3�is� Mailing Address: Zz -2
I hereby certify that I own property adjacent to the above referenced property. The individual appl
has described to me as shown on the attached drawing the development they are proposing. A description of draw
with dimensiubs. 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]
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 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 distanc+
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.)
�y
I do wish to waive the 15' set back requirement.
I do not wish to waive the IS' set back requirement.
(Property Owner Information)
i ignature
Print or Type Name
Mailing Address
(Riparian Property Owner Information)
J
Signature
lard
Print or Type Name
Mailing Address

ira) R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Fre
Governor Director Sec
AGENT AUTHORIZATION FORM
Date: S �L — / /
Name of Property Owner Applying for Permit:
Mailing Address:
... - . . .... .
Phone Number:
I certify that 1 have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
construct (activity) Or
at (my property located at) / G ��--2rr�t�n;
This certification is valid thru (date) l S�
n ..r O_ - l // t - 2 - /_-Z-

oplicant:
•�/'� -'1 CiCOPermit
ate: 511711 . �
!scribe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
and in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
bitat Name Choose One 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
temp impacts)
FINAL Feet
(Anticipated fii
disturbance.
Excludes any
restoration an(
temp impact
amount)
/
O t'
Dredge ❑ Fill ❑ Both ❑ Other A—
/ %V
/ y �/
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ElBoth ElOther ❑
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 ❑

Mareene Construction
P. O. Box 370
Supply, NC 28462
0
1216
66-11 vs31
DATE
?F /v / / $
jA
CO2 ,,qq
�y DOLL.ARS u aa« �^
Od
BRANCH BANKING AND TRUST COMPANY
I.800-BANK BBT BBT.com 04 td C ll
"'0000 L 2 16n' ':0 5 3 10 1 1 2 L':000 5 104 2 13 3 L8n'
��r