54507D - Butler

LCAMA / ❑ DREDGE & FILL
1{ENERAL PERMIT Previous permit#
1New ' ❑Modification ❑Complete Reissue ❑Partial Reissue 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 7N , ��
❑ Rules attached.
t Name t 1'On Poe- 12JL + j C_*-- Project Location: County &Yun sw i c k.
po 2x)x jSO U Street Address/ State Road/ Lot #((s) I
Lt I6--^J . State Kt ZIP V 51 iJ L 1;)(�
Subdivision
ed Agent City f Vi C.- ZIP_
❑ CW ❑ EW )(PTA 1}FS ) f PTS Phone # a 31 ".Z 70 t River Basin L, Uh
❑ OEA ❑ HHF ❑ IH C UBA ❑ N/A Adj. Wtr. Body it % nat
❑ PWS: ❑FC: Q
yes /Ono PNA yes /n Crit.Hab. yes / no Closest Maj. Wtr. Body ��GJI�
' Project/ Activity
--1- 40 P
/,t
(Scale:

NOTES
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27 10 C7:44a Gre: Holden 842980G P.1
AUG-03-2007 10:02 From: To:8429006 P.2
CEitTIFJEU MAt1G - RFiL1A14 R�CFMRFQUF�7'Fn
QIM15i.4N QF MAN&CabdENT
t1 JA CN--( JU'._ R" PROPERTY QMfNE9.rJQTl1F1g,6nON1WAIyER FORM
The purpow of this form is to providt proper notice to yov as an ai'pixta riparian property owmcr to the individual or
individuaJi listod below. The CAMA Getiml Pcrmir application prccaduras roquiro that applicants provide rbt: Division of
Coastal Managemem confirmation that a wriaon stuuament has been oWaimd signed by the ad*cnt r*nan property owners
indicating that they have no objection to chi; proposed wort[ 2L that the adjacent riparian propotty owners have been aotilyad
by certified moil orthe proposed work. Often tltema fomts are submitted to the adjacent npunsin pmpeny omvm by n monne
contractor or oLve mdividwis acting as an authorlxed agow ore beretfof the applk2w.
'Phis forma wus sent to you by the following iatdMduat or company deslCoated by the applicant as an
authorized apt: f
,
f
nt+thorizad Agettt s Signnmfc Dotc
Name of Individual Applying For Perrriii, �.�..I..1.��
Address of Properry:�j� tel: Li c`�,
(Lot or Street J . Street or Road)
&C
icy et►d County)
hereby certify that) own property adjacent to the above -re fertnced property. The individual spplying for this perr
as described to me as shown on the attached drawing the development they are proposing. A de5cr iptren or dmwir
with dimensions, should be provided with this letter.
_- I have no objections to this proposal.
if you hove objections to what (s being proposed, plcose write the Division or coastal maeagemsnt. i
Curdinut Orive Exmnsian, Wilminktoa, NC 28405 or toll 910-796-7215 within 10 days of receipt of this noti
No response is considered the same fits no objection if you have been notined by Certified ;Masi.
N
WAIVER SECTION
I understand that u pier. dock. mooring pilings. breakwattr, bast bouse or bout lift must be set buc
vinimuat dlaaunce or 15' rrom my area or riparlon access-,u111e7g • ili rved by mt. (tryou wish to waive
setback, you mast iaitial rbc appropriate amok below.)
I do wish to waive the 15' setfiack requirt micnt.
i i wish to waive the 15' AtbnLk mquiremenL
A A
Sign Narnea 1 ^� ate f NCDENR
1/

plicant:.1JS //� p r 'gce f ` LO!L Permit #:
te:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
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
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fin
disturbance.
Excludes any
restoration anc
temp impact
amount)
�' %✓
Dredge ❑ Fill ❑ Both ❑ OtherA
�p
/
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 ❑

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lete items 1, 2, and 3. Also complete
if Restricted Delivery is desired.
your name and address on the reverse
t we can return the card to you.
h this card to the back of the mailpiece,
the front if space permits.
Addressed to:
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❑ Agent
The AAddressee
eceived by (P 'n Name C. Date D ivery
Ll
D. Is delivery address di f epfrom item 17 ❑ Yes
If YES. enter deliveN ad ress below: ❑ No
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