55882D - DeSelms

-X,CAMA / 1 DREDGE & FILL r�I
GENERAL PERMIT Previous permit#
XNew - - 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 I SA NCAC ��
j Rules atLached.
Lnt Name �{/( �� J �Q ��' 1Nl S Project Location: County
�s 16,23 F I Cur+ Street Address/ State Road/ Lot #(s)
Cks LVIVI II StateNC ZIP Z?5 �H a ` if �I'1
( ) � ACV(
# ( ) Subdivision b(I1 kylb �1
ized Agent f 111 1 ACV( n Ca s�� ci City Jam►✓ l)l / _ '1 ZIP /Z�B��� q
d ❑ CW O,EW YPTA ❑ ❑ PTS o� �F ( ) w � �f - River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A I Y� � f ��—
❑ PWS: ❑FC:
yes t no PNA yes no
A Project/ Activity 1
i
lock) length x c6 ' 1
,/
m(s /' S-4 1
pier(s)
length
umber
!ad/ Riprap length
vg distance offshore�T t
iax distance offshore_
channel
ubic yards _
imp
)use/ Boatlift (�
Bulldozing
b1�i�t'rtv2F
ne Length
not sure yes no
`I
cgs: not sure ,yes no r �1
)rium: qn/a snos noAttache;;,ess
no l
Adj. Mr. Body Gt A S ! nat
Crit.Hab. yes / no Closest Maj. Wtr. Body n� `
ling permit may be required by:J-,A)'V } i A j"
. — .... -1-1t 1 r% R A
(Scale:
❑ See note on back regarding River Basin

!9UIu! llalUII!;a LJVPC"IILI110:1t UI i_11VIIU!III falIt Q1ju IYQtUICt1 r\CZUUIt,CJ
Division of Coastal Management
%.ichaei r. 'Easle%, Governor James H. Gregson, Director WiiialT G. RGSS Jr., SeCretari
Date
q�► �°
Name of Property Owner ,.pplying for Permit;
Mailing Address:
(oa (,ti,n.'f1 Cfi. gatfcsoAd-►Ie
Zer that I have authorized (agent) c��'"' ��i b�v to act on my
;half, for the purpose of applying for and obtaining all � A Permits necessary to
'1
'tall or construct (act ity) L,*, A x7- .1,z
:may property located at)
This certification is valid thru (date)
Date
12 Cardinal Drive'Ext.. Wiiminaton. ?forth Garoiina 2R4.05-.1RAS

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTTFICATION/WAIVER FORM
The purpose of this form is to provide proper notice to You as an adjacent r ipanan property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owner
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
contractor or other individuals acting as an authorized anent on behalf of the applicant.
This form was sent to you by the following individual or company designated by the applicant as an
authorized anent:
71'tS - CA.J.1io y P�z�i�1Jt n,��!
Author AgenCs Signature Date
dame of Individual Applvi�ig For Permit: 3A471 f
Address of Properr-: 60 VZ (; -//> Jrl—
(Lot or Street =', Street or Road)
(Cin and Co nty)
: Ihereb} certifv that I own propercy adjacent to the above -referenced properry. The individual applying for this perm
,ibas described to me as shown on the attached drawing the development they are proposing. A description or drawins
tth dimensions. should be provided with this letter.
&1fr 1 have no objections to this proposal.
U?
Tf you have objections to what is being proposed, please write the Division of Coastal Management, 12
;cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215 within 10 days of receipt of this notic(
: o response is considered the same as no objection if you have been notified by Certified MaiL
WAIVER SECTION
€ understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back
minimum distance of 15' from my area of riparian access - unless waived by me, (If you wish to waive th
selbacib. y u must initial the appropriate blank. below.)
I do wish to waive the 1 5' setback requirement.
1 do not wish to waive the 15' se ack requirement.
q1) 121(6.
Date NCDENR

=rotn:Soutr•tside Nechanical Services 434 799 1716 091'29/201U 09:17
Q25 P. 001 /00'
v'�ION bF (`OAS'iAL IvSAN 4GE�.LNT'
JA .LT RMARIAN. B9OPERTYOWW ER N�TIFICA-nON!WAIIVER FORM
The purpose of this form is to provide proper notice to you as an adjacer„ npariati property owner to the-individttal cyr
individuals lasted below. The CA.MA General Permit applicaticn procedures equire that appiicaltS provide the i7iviston of
Coastal Management crn{rmaror tha? a written statement has been obauned signed by tbn adjacentriganan prap4rt-,. owners
irdieadne- that they have no objecru,n cc f1ie proposed woric gr chat :he adjacem riparian property owners have bee; 1:0tifled
by cenfflicd raga] of the proposed work. Gftcn these fo- m.a wn 3ubmadjacent ined to the rip.=an-property owncra b.Y a. rner:r..e
consactor or other in&viduals acting as at authorized agen: on belalf ofthe applicara.
This form was sent to you by ike following individual or company designated by tbe;agphcant as as ;
autborized Agent-_
Name of Individuai Applyfi g For Permit.
Address of Property: -� a C-,
(Lor or Straet #, Stree- or Road)
(City and County)
ereby tern fi that I own propesry adjacen- :o :h. above -referenced property. The individual applying for rhis,permit
s4escribed to me as shown on the arrmched drawing the development they are proposing_ A description or drawins_
�h dimensions, should be provided with this lertzr.
t have no oojections :o this proposal.
:-you' have objections to what is being proposed; please write the I'IivLs=oa cf Coastal MALLagement,_ 127
�41 I)-ve Exrension, Wilmington, NC 29405 or call 91,0-796-7215 within 10 days of:'eceipt of this narfce,
a:�#ponise is considered the same -as no cl?jecrion if you have been notified by Certified N14%
WAnrER SECTION
I tm4etstand that a pier, dock, mooring pWags, breskwater, boat house or boat lift antis: be s„ t barn a
distance of i5' i'rorn my area oi'rirariata access - uniesc wr3lved by nie,..-(?; you wish to Trai*re the
;yoh Faust fuaitiat the appropriate blank beinw.)
I do wish to yaasve the i 5' sesbacit requirement.
I do. not wish to wii y-i ltk# IS' se?Sack requirement. a
`A
v DateQq

�VAO

i

Division of Coastal Mgt. Habitat Impact Computer Sleet
olicant: h'15 i �jrC S Permit #:
te: 16
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
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 fina
disturbance.
Excludes any
restoration andh
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill Both ❑ Other ❑
T�
Dredge ❑ Fill Both ❑ Other ❑
55
55
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 ❑
3x7_Z -- Cp C, -t-

PILINGS AND MORE
JOHN CASSIDY
PH: [phone]
169 LAKE HAVEN DRIVE
SNEADS FERRY, NC 28460
PYto the
border of
.sS Le
®g Citizens N�
�rstcitizens.c('_7
For
5932
L 66-30/531
Date 457
Dollars
NP