54479D - Brown

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
New ' ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources _
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
ff "� 1 - ules attached.
t Name \� ti4�n Y1(.dt ti IQ h Project Location: County i�E��cic r
s C > IcWwi Aw, ��� 2' }�� Street Address/ State Road/ Lot #(s)
)\J41aM State, ZIP Zr i \
ized Agent ►'"Gt+YI Cj[ k-b o G Vl
.d ❑ CW AEW ❑ PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes no PNA yes /(no Crit.Hab. yes / no
of Project/ Activity
01
lock) length
rm(s) &4 ' Z
pier(s) f x
length
camber
:ad/ Riprap length
ivg distance offshore_
nax distance offshore
channel
:ubic yards
amp
Ouse/ Boatlift
Bulldozing
ine Length OD
not sure yes
ags: not sure yes
orium: n/a es
s: yes
r Attached: yes
ding permit may be r
136ic ', 13vk La ICI 1 na Glvd,
Subdivision
CiUmalI f�fGtk ZIP
/
P o en # (9 jD )1�30" S5GO I River Basin Q
Adj. Wtr. Body I �KV //�� ' �111..luk Ili' t
Closest Maj. Wtr. Body A i VJ VJ
1 /i
I (Scale:

. .
G- W +'1
P E 2 Z6b,
y S"
3 0 84

BIVIsION OF cO&ST&I.. M&N&GE WNT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
dame. of Indv-Aduat Appty�ng k ddress of Property: :
p 3l
`Ldt ar Strcx� � , Stre�k. or Road}
1 'c�54q,. I -'ham . �e.-i cue
(City and County
0
_ hereby certify that I own property adjacent to the above -referenced property. The individua
wty mg fot this pumit has described to nne as shQ wix on the shack_' d d1mw ,ng ttve de�retolxnent the
are proposing. A description or drawing, with dimensions, should be provided with this letter.
V I hwm no ob3ootiaas to this proposat.
If you have objections to what is being proposed, please write the Division of Coasts
M[aaagevaeat, 127 Cardinat Drive Extensiaa, Witc i%%taa, NC 2 UQ5 ar calt 9 t4'I96-721
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat bouse orboatliit mustbe
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If va
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• 1 S' setback requirement.
00,
96 Name Date
P_C.ti "rk ca �O (Q P A_) AAA

DWISION. OF CO AS'T AI, AN ACEND EN T
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
,lame of Individual Apptyiig Far Pcmit: _
Udress of Property: J 3C) IP 13
(Ut ar Street #, Street ar Raad)
(city aid County)
rwa n �l� U-(� L4 E
C -01 :
PC��
hereby certify that I own property adjacent to the above -referenced property. The individua
Lpplyiig far this pemit has described to pie as shawl ai the attached drawing d%e, &evert the
ire proposing. A descripti or drawing, with dimensions, should be provided with this Ietter.
I have is ob3eetim% to this prapasat.
:f you have objections to what is being proposed, please write the Division of Coasts
4awa%eme,at, 127 Cardi%%t Drive Ebtegsi4m, Witvaiagtoa, NC 2MOS or call 910-796-721
within 10 days of receipt of this notice. No response is considered the same as no objection i
rou have been notified by Certified Mail.
WAIVER SECTION
. understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be se
)ck a minimum distance of 15' from my area of riparian access - unless waived by me. (Ifyoi
vish to waive the setback, you most initiat the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
,ign Nam4q,� � . v Date
AVMXw

ENR
Notch Caroiina Department of Environment and Naturai Resources
Division of Coastal Management
.UW)ZeJ F. Ea4ey, Gax=v James K Gregson, Director
Authorized Agent Consent Agreement
WMAn G .R051; if., Set
I is hereby authorized to act on my beh2
(Printed Name of Agent}
,1 order to obtain any CAMA permit(s) required foc the Property ii5ted below. The authorization is limited to
pecific activities described in the attached sketch.
_OCATiON OF PROJECT:
13l a(`
e- Qccj� N-Z :��A Q rQCd P 1%2'r
R�.�� L�r
PROPERTY OWNER MAdt_ NG ADDRESS:
- IC(n , Ie- I,--c
K� /-p P ONE NO.. 3 3�
0.�lT!-laRtZEQ AGENT MAlUNG A,QQ4?ESS.
2-IL-1 l}ft6Z�IS �Z.C��O
SCA-C-L-
`L; 5,-f©
PHONE NO. L110 - I�C)— 55Dl
Signature of Property Owner.✓ �W
Signature of Authorized Agent:

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
,1plicant: RV `gown s.'Sa "A T 1) rn&n Permit #: 5447 -q T
ate:
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
and in your Habitat code sheet.
dbitat 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 and
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other ❑
/Au
du
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 ❑

TILLMAN LLC 04-08
53 KINGLET CIR
GREENSBORO, NC 27455
Pay to tfie 4 / C L N
Order of _
Qlllk-
SuN RUST ACH RT 061000l 544 D \ / Pg 1
L,�i�'9�L 4 &" 1 T1 J
FOR
11000 1 1 2 5110 i:0 5 10000 2D:
Date -I-- v y /
100005464129t.11' %/LGA4A,