55875D - Dobzynaik

. CAMA / DREDGE & FILL •-
3"E N E RAL PERMIT Previous permit # 1
--New uModification uComplete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources ( '
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �t
i r l ules attached.
it Name l� 1 a V1 IJ w1 Project Location: County CJRSI CW
1634 ptyid)tm UmL
C' Street Address/ State Road/ Lot #(s) S%ruk
JOA - State b ZIP � G 0
Fax # ( ) Subdivision
:ed Agent V1 `' G — h '�1 • �ity�1-t�Llp ZIP
❑ CW YE XPTA ❑ ES ❑ PTS jPghmne # 2- River BasinA�
C' OEA -' HHF ❑ IH ❑ UBA ❑ N/A 1
Adj. Wtr. Body
C PWS: ❑FC:
yes / no PNA f es no Crit.Hab. yes / no Closest Maj. Wtr. Body
bf Project/ Activity
lock)length
rm(s)
Jx
pier(s) -3 x n I l �^ a —
length S _-
camber -
md/ Riprap length _
Ivg distance offshore � i .
nax distance offshore
channel 1
:ubic yards � � �� -`
amp
71
)use/ Boatlift ' Z ix I Z
Bulldozing _
-- AF —1
ine Length Q ! — — —.....
4-
not sure yes no �L T
igs: not sure yes
:)rium: n/a yes no \
O i
-- - --
yes no -
Attached: yes no
Jing permit may be required by: CV✓0CW �. `!� 1
/ C --- :.J i^__�:�:___ '10 171h A / . A A t f f,J , n .1 1--7 a i; I-1—r t,.
(Scale:
❑ See note on back regarding River Basin

Division of Cloast-all Mari acrom i ent
kqjchac-j F. Easley. Governor james H. (3regsor, Director %A611IF-m G. Poss Jr, Secfela,-Y
Name of Property Owner Applying for Permit.
Vlailing Address-,
1-a17�
on my
that I have authorized (aLent) to act
er its nee-essan— to
ning 21 C4301A F 7,01
L� for the purpose of applying for and ab-tai
o r cowtract (2etivitY)
erpyoperty located at) /-9CV-7*k A?Z-71
- IOC37
r thru (date) Ceriffication is Valid
845

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WANER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division �f
Coastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owners
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
ne
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian pro peny owners by a.trtan
contractor or other individuals acting as an authorized agent on behalf of the applicant.
This form was sent to you by the following individual or company designated by the applicant as an
authorized aglnt: /f
Authorizeent's Sipature
9'vAn/
Date
Name of Individual Applying For Permit: N/
Address of Properr :
(Lot or Street r, Street or R�
(City a4td County)
1 hereby certify that I own property adjacent to the above -referenced properrv. The individual applying for this pern
has described to me as shown on the attached drawing the development they are proposing. A description or drawir
with dimensions, should be provided with this letter.
µts --- I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Management, 1
Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796- 7215 within 10 days of receipt of this notii
No response is considered the same as no objection if you have been notified by Certified :Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set bah
minimum distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive a
setback, you must initial the appropriate blank below.)
I do wish to waive the 1 setback requirement.
+1^c Lam. I do not wish to waive #te 1 5' setback requirement.

Consent for Use of General Permit 7H.1200
Lot Number/Address: ir:►�j -� Alviji-ar\ bye
County: �j/�I Subdivision: 6\j
Criteria:
(check all that apply)
APrimary Nursery Area.
IX Less than 2.Oft deep.
❑ Greater than 2.Oft but less than 3.Oft.
❑ Submerged Aquatic Vegetation.
❑ Bottom habitat.
Comments:
Decision:
❑ Issue General Permit
❑ Elevate to Major Permit

3/-
:5-'- �d °
PlaBY�,

Message Confirmation Report
lame/Number
919103276353
'age
2
;tart Time
OCT-12-2010 08:49AM TUE
slapsed Time
01'06"
lode
STD G3
tesults
[ O. K]
OCT-12-2010 08: 50 AM TUE
Fax Number
Name
State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
Beverly Eaves Purdue, Governor
FAX COVER SHEET
Dee Freeman, Secretary
Date: .101 No. Of P ges: (0
To: From
CO: G CO: Dlvislon
Wing eovor) 1
Ilkw
oastal Management
FAX # FAX#: 910.395•
REMARKS:
12t CaMIMI0 EMnbn, "lminplon, N.C. 2ws"ME T.,W. 01 11S I..) 11M
An Equo Opportunity AMmr1An Aotlon Empl
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we cao return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
A. Signature
❑ Agent
X ❑ Addressee
B. Receiveby (Prime me) C. Date of Delivery
C)_ a
D. Is delivery address different from item 1? Yes
If YES, enter delivery address below: ❑ No
n

Division of Coastal hlgt. Habitat Impact Computer Sheet
)licant: bOb-1-4vuak, MaA&j Permit #: P5�g
e: I / Z7-l o
Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd 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 and/(
temp impact
amount)
5
Dredge ❑ Fill ❑ Both ❑ Other
��
D
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 ❑
n — 12xIZ -- lye

PILINGS AND MORE
JOHN CASSIDY
PH: [phone]
169 LAKE HAVEN DRIVE
SNEADS FERRY, NC 28460
P tothoe N
Dale
Dollars
First Citizens Con)
ank�fB tccilizzens.co
For—
':053 L00300i:00457 L3 270 13005909
5909
66-30/531
457
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