55871D - Formy-Duval

'AMA / DREDGE & FILL y
ENERAL PERMIT Previous permit #
Jew. ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
:ed by the State of North Carolina, Department of Environment and Natural Resources
astal Resources Commission in an area of environmental concern pursuant to 15A NCAC 141. �2 e, ,I) c,
//E44hiW attached.
Project Location: County Gj c/ ,✓ S w��/�
ll t/ 11,0 S 4 2 -e Street Address/ State Road/ Lot #(s) e/%
2 b4 in, Stated ZIP 2 721
/9) 6 y/-.7 4'1 y Fax # ( ) / /
d Agent C!I i C I- C 61I+ ' 1,2 41e- �..
❑ CW BfW ❑-"A --EKES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Subdivision
City < PGn.� 1 P c9c fi ZIP 2
Phone # ( ) // River Basin L ./.v-0/ e
Adj. Wtr. Body �O�✓/�L d7-/��✓ `(n. /
Closest MaWtr. Body
!s / PNA yes /�o�_ Crit.Hab. yes / no j.
'roject/ Activity ^ �� �%' L� r i r S7`. /r 1 -2)a
(Scale:/
.(s)
;th
per
Riprap length_
listance offshore
distance offshore
-inel
yards DTI— —I— F—I — —� 1--4 4 1 G
tached: yes ( °
permit may be required by:C�rj ✓ -S P �l�Cl, ❑ See note on back regarding River Basin rul

0GA10/10_0 04.3—, 7Iabiyteye
00% CON
WA. .
I`rl4h ri •!`�'.'ii+ �1:,-,�'�.f't'�t of Cny;i�', R-f 171• RJFtWFIl RMTIT"
c" coaa''31
Beverly Eaves Roidijo .an -As H, C.,Sg. .
Governor
PW— - U
Des Fr aeman
'A.--N U i u`i �iuN F RM
Ngme of Propa�t r :YT.9f t: Nit a of AuthorUed Agent fvr this praiect:
Q I I
Owner's Mailing Address: kpj nt's M.7ilinq Address-
4 L
Phone Number Phte Number
i %tsrt&y� trial i have authorized the agont Pis d ;oCJr: `w ctin my behalf, for the purpose cf apYlying
for and obtaln.ng all LAMA Parmits necessary to install or
(my property loc,itecJ) at
T!1!�] rp t 1421t101 ig �rgliri tF"t1'•+9t+1 � .C.y %do
the following (activity)

i e-4 hO-IL L-
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
- DIVISION OF COASTAL NL�rAGEivIENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
!ame of Property Owner:
'Al,ddress of Property: `
t Uvlr�e T)c m
' (Lot or Street #, Street or Road, City & County)` / C
Lpplicant's phone Mailing Address:
CSc`irQ C'��s c �J� �C`ocan � �tC`R ILL 21q�
hereby certify that I own property adjacent to the above referenced property. The individual applying for this pen
as described to me as shown on the attached drawing the development they are proposing. A description of drawi
✓ith dimensions must be provided with this letter.
_ I have no objections to this proposal.
I have objections to this proposal.
f you have objections to what is being proposed, you must notify the Division of Coastal Management (DCb
a writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive I
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
onsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
.5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial'the
Lppropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back
Property Owner I formation)
Signature
Print or Type Name
2 C-
Mailine Address
arian Pr Mty Owner Information)
V -2--Teiw A
Print or Type Name
< "/tr /9 wdaJ
Mailing Address

> c_d i1V,i: L-
CERTIFIED MAIL — RETURN' RECEIPT REQUESTED
DIVISION OF COASTAL NUA.NAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ame of Property Owner: , gbh n* U 1 g n e To - M
ddress of Property: `T� n rvt 1dc CzU n
(Lot or Street #, Street or Road, City & County)
.pplicant's phone #: ��� "(pLI I "Li�I Mailing Address:
211&
hereby certify that I own property adjacent to the above referenced property. The individual applying for this pen
as described to me as shown on the attached drawing the development they are proposing. A description of drawn
,ith dimensions mast be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
[you have objections to what is being proposed, you must notify the Division of Coastal Management (DCN
i writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive E
Vilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
onsidered the same as no objection if You have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial'the
ppropriate 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 I formation)
>ignature
)A) - �*X
'Tint or Type Name
M7- erty Owner Information)
Signature
,a",
Print or Type Name
vlailine Address
Mailing Address

+Q -� 1013
,ql ��E
all
O l _L7 -)I� / \"'' b�A ) p(I

icant: ,} �' 1j N Cr �; /" Q �� ti'/�1 j _ ��f L,19 Permit #: ) T 7/
Bribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat 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 final
disturbance.
Excludes any
restoration and/c
temp impact
amount)
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

UKICit UUM I KUU 1 IUN yr
BRUNSWICK COUNTY INC
PH. 910-579-9095
6616 BEACH DRIVE SW
OCEAN ISLE BEACH, NC 26469
DATE
PAY
c
TO THE � � I $ 2_06
ORDER OF
DOLLARS a
BRANCH H BANIONO AND TRUST COMPANY
1 14BANKEW BWAM
L�-1 -?--, \ b - cAf �!5�1 I �m) �L ---. - ___
FOR
II'00007 L0711' l:053 LO L L 2 Li:0005 L999 265 2911'

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Pririt your name and address on the reverse
so that we can 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:
Vi (Na\d JW,5:k r Ok\\Y�k m
A.
by (Prinfed Name) I C.
A
of Delivery
/
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. jervice Type
AN Certified Mail ❑ Express Mail
❑ Registered AiVReturn Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7003 1,680 0004 9790 7335
(transfer from service label)
PS Form 3811, February 2004
U - .. ,
Postage $
Certified Fee
Postmark
m Reciept Fee Here
nent Required)
d Delivery Fee
nent Required)
)stage & Fees
%- - ----------------- ----------
x No.. ROB u ---! `-(
ic�ri +0-'i n �
300, Ju.ie 20L
Domestic Return Receipt
■ 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 can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
102595-02-M-1540
CERTIFIED 1 •
•
IU
m
(Domestic.Mail Only;
tti
DoNil-
Postage
$
E3
0
Certified Fee
1:3
C3
Return Reciept Fee
Postmark
(Endorsement Required)
Here
O
Restricted Delivery Fee
cC)
(Endorsement Required)
—0
r-i
Total Postage & Fees
$
m
O
C3
Sent To
a
f
Street, Apt_ A-10— r !
or PO Box
C� , State, ZlP -- ------ ---i
......... -•---------•
PS Form :rr June 2002C
A. Signal
❑ Agent
❑ Addressee
rB i d by (Printed
Print d a�e) WDateof Delivery
D. Is delivery address different frori!i item? ❑ Yes