54448D - Atlantic

CAMA / DREDGE & FILL_:
iENERAL PERMIT Previous permit#
New --,Modification ❑Complete Reissue 'lPartial Reissue Date previous permit issued
ized by the State of North Carolina, Department (% Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 4 H'. Of ac
j� 4 Rules attached.
Name 1-11-�� M1b1hC AV1A L Project Location: CountyT✓
State ZIP ZMD
0 ) �56-qq 0 Fax # ( )
AgentUj�lY1
CW EW PTA ❑ ES ❑ PTS
! OEA l HHF ❑ IH ❑ UBA ❑ N/A
C PWS: ❑FC:
yes �no) PNA yes i no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
i G 1 "'b-e I
Subdivision
,-ity(� + ZIPV�
Phone # (o River Basin
Adj. Wtr. Body , a 1� C %a tit nc I nat
Closest Maj. Wtr. Body At w W
�f Project/ Activity + �)Cl b A wit 1JS
lock) length (Scale: l /�'
length
lumber
ead/ Riprap length_
ivg distance offshore
nax distance offshore
:ubic yards
Bulldozing
ling permit may be required,by: J O W bt VU
W r3V it t-f WALL. ❑ See note on back regarding River Basin i
nIf AU4►„ jr-r.t,I C-"L,n,..1 (—,l -nI—,._.I.L e-, ,

P,0 80x M8
gVripht Vft8eoCh. NC28
(910)25
REC'D MAR 9
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71CC

NCDENR
Svr;n Carolfna ?JeparEment of Fm.,fronnfent and Natural Resources
Division of Coastal Management
Mi&tapl E Easley, Governor Charles S. Jonas. Director W"I;tam, C
authorized Agent Consent Agreerne
Al
is hOrphv at ithttri��ri to a
----- _ _ _-- - .Pnnled Name of Agenff
in order to obtain any LAMA permit(s) requsred `or the property `Ested below. The authorization i
specific activities described in the attached sketch
LOCATION OF PROJECT:
/0 161� yy - -
�✓ � ,� 9&�t w, A&
PROPERTY ;.OWNER MAILING ADDRESS:
R-A 65�
Allujti) ,
AUTHORIZED AGENT MAILING ADDRESS:
N 11 1.._ 1 •
PECEI
QED
MAR 0 9 20io
OcM W/CM/N0r
0N, NC
PHONE N31 /1���✓6� ! �l�
--- — P/�/

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit
Address of property, f
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit has described to me as shown on the attached
drawing the development they are proposing. A description or drawing, with
4A
dimensions should be provided with this letter of notification.
j-`release initial below if you have no objections,'�.Yyhfi
/v
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 910-
same
10 days of receipt of this notice. No response is considered the
same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must be set back a minimum of 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 wish to waive the 15' setback requirement.
I DO NOT wish to waive the 15' setback requirement.
�� d - Zy� 7 %� Signature & Date
5VII Print Name

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit A/04 4'g-1
Address of property
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit has described 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 of notification.
Please initial below if you have no objections.
_
I have no objections to this proposal rill ��iF.3
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, N. C. 28405 or call 910-
within 10 days of receipt of this notice. No response is considered the
i96 - '7)/S—same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater,boat house,lift or
sandbags must be set back a minimum of 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 wish to waive the 15' setback requirement.
I DO NOT wish to waive the 15' setback requirement.
L 2 3 Signature & Date
Print Name

Division of Coastal Mgt. Habitat impact Computer Sheet
AAM
ilicant: �^ `�c
e:
3/1q Io
All values should
match the name, and units of measurement
scribe below the HABITAT disturbances for the application.
ind in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft. TOTAL Feet FINAL Feet
(Applied for.
(Anticipated final (Applied for. (Anticipated final
dist urbance .
Disturbance total
Di
DISTURB TYPE
disturbance. Disturbance
Excludes any total includes Excludes any
ibitat Name Choose One
includes any
anticipated
restoration any anticipated restoration and/a
temp impact
restoration or
temp impacts)
and/or temp restoration or
impact amount temp impacts amount
Dredge ❑ Fill ❑ Both ❑ Other
ow Dredge ❑ Fill ❑ Both ❑ Other
Ovv 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 0 Both 0 Other 0

Nvision of Coastal Mgt. 1-13bitat Impact Computer Sheet
ant: A-Nmi 'c A(kV)At CVo Gd 1'IL/ YVIYL Permit #: Cj 4y`� O D
N,i , 0 J
ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
in your Habitat code sheet.
at 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)
Dredge ❑ Fill ❑ Both ❑ Other
ZZ
�J
Dredge ❑ Fill ❑ Both ❑ Other
Z
Dredge ❑ Fill ❑ Both ❑ Other
7-4
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 ❑

F AND S MARINE CONTRACTORS, INC.
P.O. BOX 868, TEL. [phone]
WRIGHTSVILLE BEACH, NC 28480
TO THE (, Jz
ORDER OF /f ��//
DATE
RBC Bank'"
R➢C Bank NSA) rM)
Gfl5444g�
FOR ® ��-TTT��.TTTb l♦
II■ 0100 36
0,
0 5 3 1008 501 -----
38243
66-85/531
DOLLARS