54016D - Poole

'CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
4New 1-�] Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
iriYed by the State of North Carolina, Department of Environment and Natural Resources ,J
coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC (` t • �� �/!
p Rules attached.
it Name llnfl [ 1 Project Location: County%e w Nf'lY/,i
SStreet Address/ State Road/ Lot #(s)
n
Dl��t State 1X ZIP
( ) Fax # ( ) ..•�'
tied agent h+l 5110►✓
YCW 1AW C.�#TA ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes / ® PNA yes / U'--" Crit.Hab. yes / no
F Project/ Activity e isfr m/ //
a F 19�Pr 1XIO *yam-.
Subdivision
City!^/a11 - -- ZIP_
Phone # O166���2 River Basin
Adj. Wtr. Bod 014&eY y nat
Closest Maj. Wtr. Body l+�", r/ ��'&e ,19
MR
=iii= �■=�iil=i�::ir�
ise/ oatf . l2 x
e Length_
not sure yes ®i T
s: not sure yes
ium: n/a yes 7l/
es no4�
(Scale: JAI �i
ng permit may be required by:
❑ See note on back
/regarding River Basin rt

SOUA�
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORIIVG PILVVGSBOATLIFi'�dFTrBOATHOUSE)
I hereby certify that I own property adjacent to c i no. j 's
(Name of Property Owner)
property located at a1`a^i F160,4 14-1-4
U (Lot, Block, Road, etc.)
on IGC�.� �ASI ,in 6`%6\a .N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 910 VY3 X17 �- Mailing Address: /09 filMo,-- r -M
r� , t-1( grya'r
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
_ J do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
RECEIVED
JUL 15 2011
DCM WILMINGTON, NC
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address I C, U Signature
City/State/Zi
:� � 1� -- 'k�L— 4ga9
Print or Type Name

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date 5' 1 P-d�!,
Name of Property Owner Applying for Permit:
�1>1 CL �C'C�--p-,
Mailing Address:
� ► � J Kc�~n P ����-h P � �-�-e
I certify that I have authorized (agent) & f''P j to act on my
behalf, for the purpose of applying for and obtaining all CA.MA Permits necessary to
install or construct (activity) pUw'VtP'A cN- P1
at (my property located at) �1 gdX
Honda "P-
This certification is valid thru (date) J- 5 l V Q G t-),
Property Owner 4ionature Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] t FAX: [phone] Internet: www.nccoastalmanagement.net

RECEIN
JUL 15 2
DCIv4 WILMING
O

■ 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.
t. Article Addressed to:C n C4-
A Sigrlpture XAgent
X ,Ej AddrE
B. R , ved bg rimed Na ) C. e t De
different from item 1? ❑ Yes
D. is delivery L�N0
if YES, enter delivery address below:
3. 5.01Y106 Type Mall
ft/Certified Mail 0 Express
❑ Registered ❑ Retum Receipt for Merchandlse
❑ Insured Mail 0
C.O.D.
4. Restricted Delivery?
Extra Fee) C3 Yes
2. Article Number -7010 3090 0003
721z 2621
___--..-.—_----- 102595.02-M-1540
(Transfer from service labE
February 2004 Domestic Return Receipt T
PS Form 3811, - -- - - -
RECEIVED
JUL 15 2011
DCM WILMINGTON, NC

C Division of Coastal Mgt. Habitat Impact Computer Sheet
D►icant: "a`V1 � �' no Permit #: �
L
le:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
DISTURB TYPE
Oat Name 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
impact amount)
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)
C
Dredge ❑ Fill ❑ Both ❑ Other
�. U
W
Dredge ❑ Fill ❑ Both ❑ Other
3�
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

SNOW MARINE CONSTRUCTION
& DREDGING, INC.
108 SUMMER SALT LANE
CAROLINA BEACH, NC 28428
PAY
TO THE
ORDER OF
IQ
Ai f
3. �A Y- I ��-
DATE
THIS CHECK IS DELIVERED IN CONNECTION WITH THE FOLLOWING ACCOUNT S
■nnnn > �n�I� �`n S i in L L 2 L1:000 5 L0 L 3 ?"39"m
1750
66-112/531
A sae°my
,❑ Feelu�e�
DOLLARS "•°