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CAMA / ,--'j DREDGE & FILL
3ENERAL 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
i1 Rules attach
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it Name k( (It 1� yi
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CW EW "PTA ❑ ES ❑ PTS
❑ OEA HHF ❑ IH ❑ UBA ❑ WA
❑ PWS: ❑ FC:
PNA (-yes � no Crit.Hab. yes(`no
Project/ Activity
Project Location: County ("ASILw
Street Address/ State Road/ Lot #(s)
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ling permit may be required ffby: - Gw ` c ❑ See note on back regarding River Basin
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'AL`'A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves perdue, Governor James H. Gregson, Director Dee Freeman, secretary
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) P / le2rl o e, o 1) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) L--"5Cal L17",t w
at (my property located at) A d d c2.SS
This certification is valid thru (date)
Name of Property Owner:
Address of Property: 86-3 eahCZC1W/C k 5A0 r-e--s 1�) r.. � n eadd _ter 7 , On
(Lot or Street #, Street or Road, City & County) L
Applicant phone #: 9/ -3 2'1- 141S 7 Mailing Address: �� me as ADO vim,
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 or 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. Contact information for DCM offices is
available at www.nccoastalmangementnet(contact dcm.htrn or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been noted 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' setback requirement.
V/ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
tgnature '
V, ,
Print or Type Name
653 &dwick lJkofeslf
Mailing Address
3n ea J e- r pt N, C z8g00
City/State2ip
9/0 - S Z"i - I *S-q
Telephone Number
(Riparian Property Owner Information)
Signature
--_S u n d 'r r:- h tt r
Print or Type Name J
Mading Address
B L*- lV C
CH)Mate/Zip % 8
Telephone Number
Feb, io , Zo
Date
Date
'0�I�aral e-ve-111
ess cxa k
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Name of Property Owner /)!
Address of Properly: (953 Adwick [)/: %�neccd5 �err1/� ®n:
(Lot or SbvW S, Street or Road, City & County)
Applicant phone #: ft - Mailing Address:. ime— QS Akcw,
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 or drawing, with dimensions must be provided with this letter.
I have no objections to this proposal. __ I have objections to this proposal.
tf you have objections to what is being proposed you must notify the Division of Coastal Aftw% m d
(DCAQ in wddng within 10 days of receipt of this notice. Contact information for DCH offices is
available at www _dcm hon or by calling 14884tiCOAST. no
response is consldWW the same as no ob/ecdon ff you Nave been noti►ied by Car~ 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' setback requirement.
I do not wish to waive the 15' setback requirement.
iP�o�ertY
l8'!
�cl�ctrc�/ life//�
Print or Type NQMI
ad'wlc-
Mailing Address
S
Cdy/Statamp
qlr
Telephone Number
(Riparian P"pgril ¢wn*A*#ormat1on)
Signature V
Punt or Type Name
q o3 G L,C,k C., :e-1�� s .
Mailing Address
S v,A-*As Fe-Vw Z-9146 Q
city/SYat&7*
cf(o --7 37t3a
Telephone Number
cXa f -al Cov e- &
C�i2eIW,ck_ ?tea S br.
150ectc/s �rry /r/C' ' Z68y O
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C Division of Coastal 1N19#, Habitat Impact Computer Sheet
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ly
Ured e rn Zb
g t 1 I LJ DUM U vu ici u
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
B AND B MARINE CONSTRUCTION
1168 COREY DRIVE
WILLIAMSTON, NC 27892
PAY
TO THE
ORDER OF
1088
W21/530
% BRANCH 776N
DATE J /
DOLLARS
WACHOVIA
Wachnvie Bank dvlsion of Weds Fargo Ba .A.
tp 5 c> - `
FOR S4P� �-- � iwWl. � Un�
11000 L0881m I:0 5 3000 2 L91: 20000 54448 700"0