57386D - Vereen

`CAMA / n DREDGE & FILL
GENERAL PERMIT
INew. . ❑Modification El Complete Reissue El Partial Reissue
Previous permit #
Date previous permit issued
•ized 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
``X Rules attached.
t Name , # i i I l __.__ Project Location: County t'w
105 b Street Address/ State Road/ Lot #(s)
i 1"ti1G� State _-zip `? �J Ll'i"CV h/AU iYiyk.,-
'A''1 4141 Fax # (__) Subdivision tS LA
ed Agent V P4 ' , %� k(l ,I '5 Z ... CityZIP Mi.,(
/j CW
f,�- EW
�❑
A PTA
❑ OEA
HHF
❑ IH
❑ PWS:
❑ FC:
yes / no
PNA
yes rno,
❑ ES ❑ PTS
❑ UBA ❑ N/A
j Crit.Hab. yes / no
Project/ Activity (, A.St mel
n
Phone # ( LD )JTU 51 River Basin
Adj. Wtr. Body a6l ' �6vli j nat
Closest Maj. Wtr. Body `W N
v
(Scale: _ !
11MIU■■■la"■o
■■■I�rAMM■:�■■r.i�;��■n�
.7.1�■■■■■■■■■■■■■■■■SOMEONE
■�r�N
C■■�■
11111NIP&I11
ngth
■
OMEN■■=
Rimy
M-MalENE
No
nber
■■■■■■a■�ilil.
�.i�iiir�■■�li�iiii�i■■■■■�
g distance offshore
■■■■■!�N■l���11■
1■I�IH11■l��l�T��!:!lI�R�■■■�
■■■■■■■�i■■■�I■■
■Oil■■■■■■■■■■���
iannel
■■■■■■■■■■■■
1■■■il■■■■
■�■■■II��Ir■■■■�
■�■■■■■�■■■:
■E:■■
NMI
■■■■■np
■�
skic yards
.■...■■■■■■A■■
I...f1...■.....■■■■■■N
.■...■�■■■:=■
11■
■■■■!1!■■■■■■■■■l
■
■■■■
■w■
■�1■-m■■■EMEMM
■■ulldozing
■
■■■■■11■■
1■■�■■■■■■■■■■■■■■■�
No
111"I
■®■■■■■■■■■■
o 1■■1■■■■■■■■■■■■■■■1
■■■■■■wA■■■■■�1■■■■■■■■[A
!�
c ic�lFwwM■I
■■■■■■■■E'il�lllllllll��
■ i��.r..l■■■■■■■■■■■■■■I
;e Length,
■■■■■■■■■■■■,1■■�■■■■■■■■■.��■■■1
not sure yes Jno
■■■■■■■■A■■�1■l�:�J■■■�■EZ!1liiltil�■■■1
■■
IF
■No
■■■■■1
s: not sure yes no
■!
:'tali■■■■C::y
-ill
-WWI
�■11■■/Timm
■■■■■■■■A!Ef■1
\'DIY■■■■■■L'■1■■LIE■E•I,i■■■■■■■■■!�!
�:::ai■1
ng permit maybe required by: O0'sl r;w ILLuh
❑ See note on back regarding River Basin r

J,
9=04eay-Q, Jeff
(4!9p) Zl4q+ 1:-;A ST UoPsaffw-w
-A
We) puqma� -To
6� -,�Mesu-.-,wa 4TUKjs —,T3 gm 3-urrana�qvo P7—, z f m,�Fddlg O;awdurldll ;aqlzoj
-oj 44T
Iva 110 "J7- iD;
- >f
xau n icaXaj xaa .10;
"Jf SO% -e WWA mositc

Cp4e'- OF
(� Va.
r�
ll�, -T-r
V%
rsr rrA,^
Aim
M)
x - secil b T*A
L �T�Z S i m r•-• /� s v -� I�,
5

N.
\IV
7-7+s
V6

LD_ omeh .
ad dnl,Nolnsurance:overagProvtded
For delive . mtormation
vtstY,our
website at www:usps:wm
co _
rO r1J Postage $
ru Certified Fee
O Postmark
O Return Receipt Fee Here
(Endorsement Required)
E:l Restricted Delivery Fee
(Endorsement Required)
O
M Total Postage & Fees $
r-
Sent
cc
C3 Street, Apt. No.; /f�J
or Po Box No. o �/ ( /� / �... -
---- --- ---- --
City, State ZIP+4
:-
, ww",
fl.J f P "_ _ - _
ro
1 t
ro
Postage $FU
ru Certified Fee
Postmark

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: c'�J 1 L ! /� y}'i z� AID
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: �l0 2 71 -6 70 / Mailing Address: ?oZ7 / l9
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this perm
has described to me as shown on the attached drawing the development they are proposing. A description of drawin
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. Correspondence should be mailed to 127 Cardinal Drive Ex
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
:ousidered the same as no obiection if You have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance o;
5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must.inl the
ppropriate blank below.) �r''� w" /i
I do wish to waive the 15' set back requirement.�,�`�
I do not wish to waive the 15' set back requirement.
?roperty Owner Information)
ignature
%�,4c „-)i)1
-int or Type Name
parian Property Owner Information)
Signature
Print or Type Name
S C� 4 7 �-� c. t o iD,
ailing Address
Mailing Address

USPS - Track & Confirm
Page 1 of
Track & Confirm
Search Results
Label/Receipt Number: 7008 1300 0000 2288 8223
Status: Delivered
Your item was delivered at 12:18 pm on March 07, 2011 in
JACKSONVILLE, NC 28546. A proof of delivery record may be available
through your local Post Office for a fee.
Additional information for this item is stored in files offline
IRrgoWO Of yAw DI�Ifs 0 tttarum to USPS. com Home >-
Site Map. Customer Service Forms Gov't Services Careers
Copyright© 2010 USPS. All Rights Reserved. No FEAR Act EEO Data FOI
Home I Help I Sign
Track & Confirm FAG-s
Track & Confirm
Enter Label/Receipt Number.
fgoz;
Privacy_Pot cy Terms of t Ise Busingss. Cu...s...tomer ateway
tst:t! 1tts �i Yes;ci�� t:�yrnu.
A t 1t�rt n t'1s� lci�� 1 irtre*gl b"I -IV

IC Division of Coastal 14igt, Habitat Impact Computer Sheet
pplicant Permit
ate:
/4
:scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
ibitat 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
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)
CWDredge
❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
L Q
Q
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 ❑

INGS AND MORE 5878
IN CASSIDY
531
[phone] 66-3a/457
LAKE HAVEN DRIVE ��� / 45
ADS FERRY, NC 28460 Date
Dhe)
ord,
f% Dollars
First citizens C�n�
Bank
firstcitizens.com
053 L00300t:00457 L3 270 y31I 05878
ru