52432D - Jacokes

ICAMA / ❑ DREDGE & FILL
31ENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources 1260
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
i
t Name /AV
State zip Z
l/'v) % "t�' 5/ Fax # ( )
❑ CW [5-EW Q,PTA rvjES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
/ Oki / C 't H b / no
Project Location: County PZ'A- %Z2'
Street Address/ State Road/ Lot #(s) Z 5
Subdivision / i fw D 6t�%L �
city :� Gl/? C / Ty zip gyp
Phone # (/C') Z3� River Basin C t'i
✓,42 Adj. Wtr. Body (I Al�f
Closest Maj. Wtr. Body TZ S 64"AIP
yes no yes no ri . a yes
' Project/ Activityn �t�sto%/ �Cct5s /Pifer /�� /�JS7'J L / z J►' /Z /D'
ck)length
ngth
mber
d/ Rlprap length_
distance offshore_
uc distance offshore
cannel
bic yards
np
is Boatl' ��,
,ulldozing
ie Length N V
not sure yes
,s: not sure yes
-ium: n/a yes
yes I
Attached: 9
ing permit may be req
(Scale:
f - . 1 - .11- — — Il1i1i ii fl rsr -nc,, "iw/

■ 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.
1. Article Addressed to:
A. Signature
X1\ t
❑ Agent
B. Received by (RLtdted Name) / Date of eliverY
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ice Type
ha Certified Mail ❑ Express Mail

1.....Q�a .,�s..,,.,_
Na"''= 0f ::ii �i'1G'l:cli �C��iy+^ ?c'11�1� 0.J e -r----
Address of Proper*- 1 13 0, K -Dv-, ve- N
(Lot or Sr., cet is, Strcct or Road)
Svr� 0 N C )yL4q�
(City and Cczn,6y
I hereby cetfy tha,, I own vel"Prty ocijUM to the abovo•refoNnOd proptrty, The im
app;3 �:ng fal this permit hn: d+e5cribed to tilt as shown on tilt &shed drawing t he dtvelopm
are rroposing, A description or %vith dimensions, s.tould be provWed with this
I have no objections to this p►oposal,
It you hove objections to what is being proposed, please write the [Avision of +
Managetnt:nt, 127 Cardinal Drive ExtenoiOn, Wilmington, VC 18400 v call 910.7i
within 10 clays of rrceipt of thic notige. No response is considered the same as no obji
you have been notiNd by Certified Mail,
WAIVER SK" TCON
I ucderstaad that a pier, dock, mooring pilings, broukwater, boathouse or joat lift mu,
bek a minimum distance of 13' from my area of riparian access • unless w aived by me.
wish to wrIve the setback, you must initlul thr appropriate blank below.}
do wish to waive the 1 S' it:ibazk rogt4rem9mr,
i v tsh to weive tr;c ; 3 sethck mquiract.en,.
Sign: date
AI A

1-7 t,

COASTAL MARINE DOCKS & BULKHEADS
NCDL 3831595
6314 WRIG HTSVILLE AVE 910-256-6357
WILMINGTON, NC 28403
PAY
TO THE
ORDER OF
E`U /2.
,,-6' s--
DATE
WA,CHOvra Wachovia Bank, N.A. 431 C R J ;�l
wechovie. !
��Cs' c FOR_
IIw0 L 68 781I' 1:0 5 3000 2 L 91: 208 6 L 70 139 "a