54417D - Black

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'01CAMA / Ca'bREDGE & FILL
IENERAL PERMIT Previous permit #
few ❑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 % N • �C�, 7%� - I Zy0
ffRules attached.
t Name (C K1.1 '� Project Location: County f3rP( I Nor ,) It, K.
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ed Agent (' tie �Ky, rl0k)QA ,ttoielA, V- NY.
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❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS: ❑FC:
yes / (iP PNA )4!v / no Crit.Hab. yes / no
Subdivision
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Phone # ( ) River Basin A?:C
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Attached: yes o
ing permit may be required by:
OffV- 1 S L ftX0 ❑ See note on back regarding River Basin i

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual Applying For Permit: (_ {��r le s
Address of Property: 14010 rAg s * Yet n% jlr le a
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The indi`
applying for this permit has described to.me as shown on the attached drawing, the developmer
are proposing. A description or drawing, with dimensions, should be provided with this let?
�_/ I have no objections to this proposal.
J P P
If you have objections to what is being proposed, please write the Division of C,
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796
within 10 days of receipt of this notice. No response is considered the same as no objec
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must
bck a minimum distance of 15' from my area of riparian access - unless waived by me. I
wish to -waive the setback, you must initial the appropriate blank below.)
Sian N
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 1 5' setback requirement.
Date
ZA D-:-.r ?�T .., *�A

Y+tI
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverty Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date 1'6/10
Name of Property Owner Applying for Pe/rmiitt::
il �{
Mailing Address:
148 Sugar Hollow Road, Lafollette TN 37766
certify that 1 ha- a authorized (agent) Cheryl Moody, Atlantic Shores Env. to act on my
behalf. for the purpose of applying for and obtaining all CA11A Permits necessary to
install or construct (actKit) a bulkhead and donk
at (my property located at) Lot 1, Block 105 Section 7 Plat 5/70, Oak island, NC
I'his certification is -alid thru (date)
Property Owner Signature
i -q-/o
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone]' Internet: www nrrnastalmannnamont not

SEPH R. BROCHURE, PLS L-1759, CERTIFY - NOTES -
THIS PLAT WAS DRAWN UNDER MY 1. ALL DISTANCES SHOWN ARE HORIZONTAL INTRACOASTAL
WATEI
:RVISION FROM AN ACTUAL SURVEY MADE GROUND DISTANCES IN U.S. SURVEY FEET
—
— -
-R MY SUPERVISION FROM INFORMATION 2. ALL BEARINGS ARE BASED ON MAP BOOK
SITED
NN IN DEED BOOKS REFERENCED ON MAP AND 5, PAGE 70A, BCRD.
EAST
YACHT
BOOKS REFERENCED ON MAP; THAT ANY 3. THIS SURVEY PERFORMED AND MAP
5 NOT ACTUALLY SURVEYED APPEAR AS PREPARED WITHOUT THE BENEFIT OF A
(EN LINES AND WERE PLOTTED FROM TITLE REPORT. THIS SURVEY IS SUBJECT
Lo
4MATION AS NOTED ON THE PLAT; THAT THE TO ANY FACTS AND EASEMENTS WHICH
OF PRECISION AS CALCULATED IS BETTER MAY BE DISCLOSED BY A FULL AND w
a
' 1:10,000; THAT THE AREA IS COMPUTED BY ACCURATE TITLE SEARCH. z
w
IDINATE THOD. WITNESS MY ORIGINAL 4. PIN#s: 235LA009
z
4TURE, ISTRATION NUMBER AND SEAL THIS 5. PROPERTY ADDRESS IS:
EAST
HOLLY
1st D F JAN ARY A.D., 2009. 4010 EAST YACHT DR.
OAK ISLAND, NORTH CAROLINA 28465
- NClNITY
MAP -
PH R BROCHURE L-1759
(NOT TO
SCALE)
E&VONAL LAND SURVEYOR
0 0 111 A 11 ",
- REFERENCES -
- LEGEND -
,\ R0�' ��
(BRUNSMCK COUNTY REGISTER OF DEEDS)
IPF
IRON PIPE FOUND
�9••••••••• Z�
••
1. DEED BOOK 2082, PAGE 98
2. MAP BOOK
IRF
IRON ROD FOUND
pFESS/0N y
9l
5, PAGE 70A
IRS
IRON ROD SET
• QP •
-
PKF
PK NAIL FOUND
SEAL
=_ • • =
L-1759 =
PKS
PK NAIL SET
�
MNF
MAG NAIL FOUND
" il9�Y r��i � :
:o • SUR`1� •
- FEMA -
MNS
PI
MAG NAIL SET
POINT OF INTERSE
)
•• •• �J
•••••
FIRM: 3720206600 J
.#'01 QG �
EFFECTIVE DATE: JUNE 2, 2006
R/W
RIGHT-OF-WAY
ZONES: AE-11
CIL
CENTERLINE
P/L
PROPERTY LINE
N/F
NOW OR FORMERL
L
GROUND ELEVATIO
- SETBACKS -
LLJ
- LOT AREA -
©
CONCRETE
ZONING=OK-R-6
0.152 ACRES
DECKING
n FRONT=25'
6,604 SQ. FT.
GRAVEL
Q REAR=20'
I SIDES=8'
MAY VARY
ATLANTIC INTRACOASTAL WATERWAY
APp_ RO ---
lEPROXIMA TE
° / RUA/E OF- IC14
--------------------
I / Ll/VE 0 4 r
/ / l ----- Mq�Sy
/PROPOSED /
/DOCK & LIFT/ IRF
LOT / p /
l i / LOT l? l

Consent for Use of General Permit 7H.1200
Lot Number/Address: 401 Z Y, �JPvro Of-r Gw
County: BC.w,--4 01CO- — Subdivision: CIA
Criteria:
(check all that apply)
Primary Nursery Area.
W Less than 2.0ft deep.
❑ Greater than 2.Oft but less than 3.Oft.
❑ Submerged Aquatic Vegetation.
❑ Bottom habitat.
Comments:
Decision:
X Issue General Permit W .Ki-
o Elevate to Mai or Permitw"" sub 3t-r
O '
- 0004� NC bhvision of Mar
Fisheries Representative
1 1- l 0
Date

ATLANTIC SHORES ENVIRONMENTAL SERVICES, LLC
PH.910-371-5980 FX.910-371-6652
154 BACKHOE RD,
LELAND, NC 28451 �'} V
i p
I i , , C N Z
1190
66-7172/2531
s 600
Dollars
COOPERATIVE
BANK y 1
LELAND, lNC
For l.' f
�
is 253 i7 17 281: 14900 18 0911' 0 1 i90
MO.-