54416D - Buff

TCAMA / i'DREDGE & FILL
3)ENERAL PERMIT
Previous permit#
]New 7jModification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized ay the State of North Carolina, Department of Environment and Natural Resources
7 4. j 7 C)L
-oastal Resources Commission in an area of environmental concern
pursuant to I SA NCAC
t Name x o IT A?r
les attached.
Project Location: County ik l
,3(G $
Street Address/ State Road/ Lot #(s) /0y S& If
-�ot*—O State N(-ZIP Z9'0�
( ) Fax # 041k)
Subdivision
ed Agent i� umwV #1 ��'�j ' `�t1 Lam( t A jMlhc',
�t ity f' &w Is C O-nZIP
❑ CW EDfW ETPTA ❑ ES ❑ PTS
S _
Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
^
Adj. Wtr. Body Vlll
C PWS: ❑FC:
yes / 60- PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Project/ Activity Pk LL L fCr 1 fV (o Q( C)/-
rr
(Scale: -
k) length
i length
number
ead/ Riprap length
avg distance offshore
max distance offshore
channel
cubic yards
amp
ouse/ Boatlift
ding permit may be required by: j
---:_� r'--- iu: f f' %- -ILL 1'7.--).') t — —
❑ See note on back regarding River Basin

1..J u v� "V L I I I -t I

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
name of Property Owner:��, _ 1VA i
Address of Property: I �• 0►
(Lot o� ls)an 14
r Street #, Street or Road, City & County)
rr�
Applicant's phone #:—�2—cl 1L Mailing Address: log b`
I hereby certify that I own property adjacent to the above referenced property. ine muiviuuai app►yiug Lu► «,.a F�Axxx-.
has described to me as shown on the attached drawing the development they are proposing. A description of drawing,
with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if ou h ve been notified by Certifred Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance 01
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
SG
Signature
Print or Type Name
_sC17_ =
Maili g Address
/ / i [/ 'T-f / ,_ /
(Riparian Pro erty Owner Information)
77
�l
Signature
Clad M00^23
Print or Type Name
SS
Mailing Address
��a X Ts lu

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATENIENT
dame of Property Owner: C 0 ' ✓ 1
J
address of Property:
((Lot or Street #, Street or Road, City & County)
%pplicant's phone #:______—M Mailing Address:
pt �
[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 descriytion of drawing,
with dimensions must be provided with this letter.
v)r_ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone], No response is
considered the same as no objection if ou have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance 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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property O Inerformation)
Signature
5'co - t �-P f
Print or Type Name I
10 Cf 3 6
Mailing Address
CMG. K Ls �a �� � C•
(Riparian Property Owner Information)
C
Signature Q j J�,Vu V lc,
# t• �tr• /vbl
Print or Type Name
L/(.o l -E, aa� I
Mailing Address
/),, k a --
City/ State / Zip

I
Z a c p OJT
1
i
I InvbI C-.�,pgrI o//C, /

Consent for Use of General Permit 7H.1200
Lot Number/Address: --
County: i kOUQ iC Subdivision: N�f�
Criteria:
(check all that apply)
Sd Primary Nursery Area.
`A Less than 2.Oft deep.
❑ Greater than 2.Oft but less than 3.Oft.
❑ Submerged Aquatic Vegetation.
❑ Bottom habitat.
Comments:
ti 11 6 N�
�i
bMMPJNJW Itti 1;f.& 7I96JWA Qai
Decision:
I
Issue General Permit
❑ Elevate to Major Permit
NC Div' i n of Marine Fisheries Representative

A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Datey i /D C, / /()
Name of Property Owner Applying for Permit:
�.. - a ->> �f�
Mailing Address:
r)
I certify that I have authorized (agent) r r fir r J to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
1�
at (my property located at) f
This certification is valid thru (date)
Property Owner Signature

SHORELINE MARINE CONSTRUCTION 66-7143/2531 1120
PH. [phone] 1201003223
1371 LONG LEAF ROAD - BSL
SOUTHPORT, NC 28461 DArE 7 _
c
PAYTHE �+(. c
S ORDERER OF I.1b $
� � � /Qr7 DOLLARS 8
SEcuRrrY
SAS BANKGPP4141(d
Southport, NC 284j�i
MEMO S6,,P_--,,t'—T g I rmn /'--------
1:2530L4301: L201003223110 LL