54558D - Allred

16� 11A PPIDREDGE & FILL
!f NERAL PERMIT Previous permit #
New ❑Modification [I Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources zJ
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /IJ /❑ Rules attached.
Name J+[ ! /rl'c�''� Project Location: County
f,r' � rr" eel 12p/ • Street Address/ State Road/ Lot #(s)
j 4-1
%ZIP 2l%
!h State
Fax # ()
Subdivision
ed Agent�Its'/") h City Sl: `'tip ZIP_
❑ CW ❑ EW ❑ PTA DES ❑ PTS Phone # ( ) �5W4W River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
AQs / no
f Project/ Activity
j�j _FmtiE_'^F"c
ine Length
not sure YesUr
igs: not sure yes n�, i
orium: n/a yes 1
s: yes
r Attached: yes 4
ding permit may be required by Aje4-V !/ ❑ See note on back regarding River Basin
Crit.Hab. yes /
Adj. Wtr. Body Uf �I cle-e n
Closest Maj. Wtr. Body ev4� " .-

It

,J irER -
���� FORYM.
/ /
Na~re of'Individ" al Appiying F," Permit. _
Address of Property
(Lot or Strect 4, Sty: eet or Road)
C `3G///
(City and County)
I hereby certify that I own property adjacent to the above-referenceu propert The indiv
applying for ;l:is per:alit has described to me as shown on the attached drawing t.h(! deveiop:nent
are p-oposind, A. description or drawinz, with dim asions, should be provided with this lette
I have no ob' ections to this proposal.
If Nou have objections to what is being proposed, please write the Division of Co'4
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or wall 910-796-'
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
W UVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must 1
bck a minimum distance of 15' fr am my area of riparian access - unless waived by me. (I
wish to 4vaive the setback, you must initial the_a ropriate blank below.)
I do to waive the 1 setback requivelme lt.
I do net -,x-ish to waive t.le i 3' setback requirement.
Sizn Nagle D to
1J--- a

NA
4'7 .:' l F o _
� "� R p :�.k.i � ^•; a � � � l' �. r� � �' �) ��"< I� ICU � � .� .
1,7amP nFlndiv.c:ua1 Apply'_rig ro: 1'ert..lt:
Address of Property*,
(t or or Sir wet 4, Stredt or R ad)
�J ,�� ""l C � /C C
(Ciry and County)
aced propert;'. The individ
I hereby 4ertify T,rat I own property adjacent to the above -referenced
a plyir:, for ,Is permit has described to me as shown on file attached drawirl� the development
p
are pro�osin�- 4 description or drativin'�, ��''�th diTietasiot�s, should be pro��ided With this etter
I ha`°e no ,gib,iec,;ons to this p-oposal-
what is bcin0 proposed, please write the Division of Con
If you Have objections to
., Wilmington, NC 28405 or call 910-^96-
Management, 1a7 Cardinal Drive Extension,
within 10 days of receipt of this notice, No response is considered the same as no object!,
you have been notified by Certified Mail.
NV A1VER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse unless o Nvaied by me. (I
bck a minimum distance of 1F from my area of riparian access
wish to tivaive the setback, you�at initial the appropriate blank below.)
1 do wash to *�;aive the 131 setback requireITZenC.
I do n.ot wz sh to waive the 1 S' setback requirement
Si _'ame
Date
A
Ek, .s A

*A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
verly Eaves Perdue James H. Gregson
ivernor Director
Dee Freeman
Secretary
AGENT AUTHORIZATION FORM
Date: S , h
ne of Property Owner Applying for Permit: Name of Authorized Agent for this project:
17
fner's Mailing Address:
C;-P ,-1<- ieW,
one Number
ell
Agent's Mailing Address:
Phone Number (13/o )9--� /- W S/ q
ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
-f c�
iy property located) at 1 C S rr /c
his certification is valid thru (date)
4 / --; �', e &A, 4- Z
Property Owner Signature
Date

Division of Coastal Mgt. Habitat Impact Computer Sheep:
11rel
,licant: J.e,4,) %� Permit #:
e: 6 //Aly
Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
ditat 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)
�j
Dredge ❑ Fill (Both ❑ Other ❑
20oe'
2db�
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑