54580D - Leplin

-ICAMA / ❑ DREDGE & FILL
3ENERAL PERMIT Previous permit#
]New ❑Modification ❑Complete Reissue ❑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 15A NCAC
` , jl� Rules attached.
it Name4 la W"It'r ►�,flUA Project Location: County LA LV
State N c, ZIPZ1514
ied Agent
❑ CW VEW PTA ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ye( / no PNA yes /; no Crit.Hab. yes /, 'no
Street Address/ State Road/ Lot #(s)
Subdivision Kti C' a
Cityzip ALALAI
Phone # 1 ) 7f t - 2213 River Basin �t
u
Adj. Wtr. Body nat
Closest Maj. Wtr. Body
f Project/ Activity
-lommim
INN
IYi MEMN■■ .ALA ■■■■■■■fig
■i��t71:i■■■■■L:;�ity:•' ■■■�■■w�
ibic yards
use/ Boatlift 2
)(IZ
3ulldozing
ne Length vv
not sure yes
gs: not SuEe yes
>rium: n/a � yes
yes
Attached: yes
(Scale:
ling permit may be required by: F V1.tk
❑ See note on back regarding River Basin i
L I. �— 4 1, ,vJ, ,, c V--t1,sI,.J

Name 0�=ndividual Applying For Permwt: Gl/'re zep/,
_ h
Address 0= property: r A✓•
S v CI
(Lot Or Street
f✓ C � S �' e/.S_ /"P%i%6
or Road, City a: COL'i'ltl'}
I hereby Certify that I Own property adjacent to the above-
-referenced property. The individual applying for this pe�rit has
to me as shown on the attached drawing the development
they are .proposing. A description or drawing, with dimensions,
should be provided with this letter. !aP✓e,Cepu-f fv �X�St"�f doci'.
�I have no objections to this proposal.
f you }te'aZTa hJ ort J =S C) ghAr- J c },c�CT 17'r"C PQnqnli
ri c al Manarsamcn^ -C"ar^ ; ra1
V7� im�narnn Nnrt-i, flriv� a r
Carolina R4QS dr r•��� a�n �c}; �4f)f1 ,��, -in
m--of 7-mr-_=J t• of t'hi p; nnti o Tin rPannrrca ; nnei rioroA + _
ac nn n�-iQ jinn if vn� nati=o },ann nntificri :.� T. o
s uuderstaud tnzt .s pier, doah, :maar pilings, bras ester, boat
aozse ar boat 1i:!t saust be set bacr �rimuu distance of ._3, gram
y'
m;" area Of =i.parian access - unless waived by .me .
�Z' ou s�ish rQ
waive the set Bach, you mw--,:: LzItial the approariete blani: belov,�. }
Z do WJ SP :.O wad v= _.he _5 ' se-z ack .- eCrUj -amen: .
1 do nnt- WISh to waive the 15 1 se`bar - -r9c ZaiitaTit_
12

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date
Name of Property Owner Applying for Permit:
Mailing Address:
eel Z)k-
r
I certify that I have authorized (agent) �G1 ✓�P��y to act on my
behalf, for the purpose of applying for and obtaining all CANLA Permits necessary to
install or construct (activity) 4©a f "r%
at (my property located at) f Z 5; /S/ UCL A d' Sq -� ("— NG .Z
This certification is valid thru (date)
Al
S i/b
prnr nrf'v N�wnar Cirtna+iira natP.

Division of Coastal N19t, Habitat Impact Computer Sheet
plicant. �� �� �J Permit #.5L45?b b
te:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
bitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
tamn imnarts)
impact amount)
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other 9 O 0
Dredge ❑ Fill ❑ Both ❑ OtherX 1144 1 LfL4
Dredge ❑ Fill ❑ Both ❑ Other
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
J., P7,, es V rs
A Sig ature ❑ Agent -
❑ Addressee
B. RecetbY(Printed ) C. Date of Delivery "
D. Is delivery address di ffereric from 1-1? 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
2. Article Number 7009 2250 0003 8169 9074
(transfer from service label) 102595-02-M-1540
PS Form 3811, February 2004 Domestic Return Receipt
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑

4114
�IRINE CONSTRUCTION INC 66.19I630NC
GHTHOUSE MAPO BO2532
X
SURF CITY NC 28445-0028 PATE
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