55873D - Massengill

(CAMA / _ DREDGE & FILL 15
3ENERAL PERMIT Previous permit #
1New . 7—[Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
; ed bA*,he State of North Carolina, Department of Environment and Natural Resources
.oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC f
I r `y Rules ittached.
t Name l t ti Project Location: County
Street Address/ State((Road/ Lot #(s)
StateNL ZIP��3U f g(fi l�(AL�0.1 11�t
270(o Fax # ( ) Subdivision {NIP
ed Agent City V YIA - ZIP ' I
❑ CW 'I EW f] PTA ,X ES ❑ PTS Phone # ( ) River Basin V
❑ OEA ❑ HHF ElIH ❑ UBA Cl N/A i
Adj. Wtr. Body �' G k�CP ♦ s nat
❑ PWS: ❑ FC:
Closest Maj. Wtr. Body
yes r/no PNA yes no Crit.Hab. yes / no
Project/ Activity LtC ma-t( Rl. w 4AA rAICQ
(Scale: I = '
:k)length
(5)
ier(s)rigth
nbee
r
i/ Riprap length
distance offshore
x distance offshore
cannel-ISx,-3X-3
kcX93 X --a.
)ic ya�ds
np y ,1
/ \, -7 ti /
ulldozing
3J)x-3&1
e cengtn—
not sure yes no
s: not s e yes no
n/a r � no -- tt
EL-_
f
cum: Mo
kttached: yes no A&Wng permit maybe required by: �Lvv
■� .,
A. El See note on back regarding River Basin n
11,1N A- A All 1. w./ t -, Al(� 1 _ ) I 1 4ri -/f i
'll l Ilr'.n. 4-11 1 I'l x-].

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
!hereby certify that I own property adjacent to �uj4sr4,!4 4, 14S ;,=NG>Lt's
(Name of Property Owner)
property located at I 7 C'- t4N A . Dizi J F-
(Lot, BIock, Road, etc.)
on CeiNAL o(V C1I&D} )iCi &t 4in 5Nt41)`p ECe-�V,()11sLDJJ Co . N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:` iq-IZ/-aIR06, Mailing Address: lI0(o IE7 uL,r3[;PPY
6QL 75 ZnRo,. iV C
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
----------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
5 CE 19 7-7-,9C�l E D
----------------------------------- --------------------
(Information for Property Owner Applying
fo-r Permit)
-------------------------------------------------------
(Riparian Property Owner Information)
Mailing Address
601-D5I�)0A0_ /V(- 275 -3o
Signature
-64vi n 0 A hh i= -r1—

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to //„iLtr M M853,=�I6t4 L. 's
(Name of Property Owner)
property located at i 7 t2iglVf1L 1Dp-f tjF
(Lot, Block, Road, etc.)
on CANAL tod dtfAWA)lell, ;bf'j ,in 5[,jEADg ECePgj, ol151-oco Ca.. N.C.
(Waterbody) (Town and/or County)
ApplicaL 's phone 9:':0- 7:31- 92C& Mailing Address:1006p
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
SEE /477rt9CifED
------------------------------------------------------------------------------------------------ ------------------
(Information for Property Owner Applying (Riparian Property Own I ormat�i)
for Permit) /.% I
Mailing Address

Vap Frame Page I&
Onslow County - GIS/Mapping System - Parcels Last Updated on: jeqp teV m .
Qui ea S�j
13,2010
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Addre�!
Parcels
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!6/2010 12:27 FAX [phone] ADANSVILLE AUTO SALES 0002
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C Division of Coastal N19t, Habitat Impact Computer Sheet
)plicanJ7 ���I(,( Permit
ite:
5/q
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impactamount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge Fill ElBoth ElOther ❑
3 fI J
3 l J
Dredge Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill 1�( 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 ❑

ILL MASSENGILL 1192
:2294838 PH 919-736-9336
NTAL ACCOUNT 66-21/530
)6 E MULBERRY ST BRANCH 03931
)LDSBORO, NC 27530
Date
$ yoo�
F..urltY
F..lur.a
� Del.lb an
Back.
wacHovIA �2 5S$�3p C06)
Wachovia Bank, N.A.
wachovia.com %
11100 L L9 2)i' ':053000 2 L9i: L03357 200864Sill

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CG��ST�i�'�;�,��Gz"v�£�T
CR TY OWNER NOTT ICATI©NIWAIV £R FORM
�rce o you as an adiacenr riparian property owner to the imfivida
i
Ferinir appiicarion procedures require that applicants provide the
!n statement has been obtained sigzned b_y the adjacent rtparm
,roposad worm or that the adjacent riparian property owmnemn hhave_ {
n these forms are submitted to the adjacent riparian properrty, o '
authorized agent on behalf of the applicant. q
,flowing individual or company designated by the PPHM tt-'
Date
Road)
Bove -referenced property. The irdividuail applying for thls>pLn
.zg the deveiopmert they are proposing. A description or drawl
er.
:oils to This propo-rai.
:posed. please write the Division of Coastal Management,;_
?8405 or call 9I4-196-72I5 within 10 days of receipt of this not
objec fort if you have been notified by Certified Mail.
Ind -ER SEC 71 ON
,00ring pdinas� breakwater, boat house or brut lift roust be set bee
! area of riparian access - unless waived by rfe; .{If you wish to wive
-opriAte blank below.)
to waive the } 5' setback 7equirernent_

AL AGENT RIPARIANPROP PR7Y O`,uViFR'NOTIFICATION/WArVERFORM
The purpose of this form is to provide proper notice to you as an adjacent riparian propertyowner to the indivi"
individuals listed below. The LAMA Genera! Per,nit application procedures require that applicants provide the I*
Coastal ManaQemenr confirmation that a written statement has been obtained signed by the adjacent riparian Pr
indicaating dm thev have no objection to the proposed work or that the adjacent riparian property ow�rs nave=. b
by certified mail of the proposed worn. Often these oni+s are submitted to the adjacent riparian presperty csc;ners
contractor or other individuals acting as an authorized agent on benatf of the applicant.
This forth was sent to you by the followiing individual or company designated by the;aOpLca�i
authorized age: /
s Sig Iarur,-
�arB
tiarrte of Individual Applying For Permwit: 111 i m'
:address of Propemv:
(T Ot or StrJt E. 4:�Qee: Or i 03Ct;
{Ciry and (_'ounr )
ierebv cerif, that I awn proper}• adjacent to the above-reterencled proper r_v_ The individual apptying for this-pe-
'sr,=descr ibeda Eo cne ass :own on the attache' draw;nz Ette developrrinem _hey, are proposing- description ordr2VYi
-dirriensions, shoulM be provided with this letter.
i have no obiections to his froposai.
�u have o, .sections to what is being proposed. please write the Division of Coastal Management,..]
jai Drive Extension, Wilmington, . C 28405 or call 910-796-721-4 within 10 days of receipt of this nab
3 ; spdnsg is considered Lire same no objection if You have beer, notified by Certified Maid
WAIVER SECTION
i uudersfand that a. pier, dock-, mooring pilings, breakwater, boat house or beat I _"t .must be set bacl
m € i distance'af 13' from tidy area of riparian access - unless waived by me (if you wish to waive
y u must initial the appropriate blank Mow.)
I do wish to }wive The I setback requirement_
I do not wish to weive ohs ? `setback requirement.f Ar_'07W

T-I I V I =mt v I i 1-,! 7-1 -W a-I'P;"! ,
zi
agson,
VOTIs-m-, G-. -Rr-,,Qs Secm-iari
Date
'•fame- off'roppertly Amer App-1-y1mg.-fole Permit,
ladinga
I laa-vre a=h, -3 rized (ap#t) to act oil my
bAlb� far the i 'a -essary, Ito tier -
or cow1vtni ct (actild-, ty-)
6py-property Iocated at) cl-,�,-w
ter Signature
'97Cinai *eE,ffilmington, NomCaoina
2E-105-3845
Z- ?
Date
010-796-721 M: 910-305-396-A' intemet