54575D - King

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
New Modification Complete Reissue Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
[?Rules attached.
it Name J�W L ! PJ1- Project Location: County Y;� f t �✓�LL' / -'!G
State is C ZIP Z CYy
#( )
ed Agent Ung ho ty el�}.t�
❑ CW [,-4W ETA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
yes /e5 PNA I& / no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City /)/�x !SC- M42 ZIP Z,'1
Phone # O River Basin L
Adj. Wtr. Body lS C 6tt411—. nat
Closest Maj. Wtr. Body A i w py
Project/ Activity rLBA � njk u Q IS' X 1LI -i
(Scale:
k) length
rm(s)
pier(s)
length
number
ead/ Riprap length
avg distance offshore
max distance offshore
channel
:ubic yards
'amp
ouse/ Boatlift? �1
Bulldozing
line Length
not sure ye:
ags: not sure ye
orium: n/a ye
yes
r Attached: yes
Jing permit may be required by: Ofh,� jst--df i� C See note on back regarding River Basin
.i 1-----i-1 Q--. dkia..,. 7 / n !/i iT , )n i C ; : %- —7H 1 Ii7,-) ) -n i r-U. n.a_—L: — Ylt-Y) n_

A
I
4
American Fish Company
..s•�',� P.O. Box 11046
Southport, North Carolina 28461
Email, AFC036000aol.com
Date
8 ( -i--),, -05 C AhI Rt,
INVOICE NO #
(910)457-
(910) 457-
20
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in510 1\ new I6f000LBLiF-+
in so -Me- Spa+
15—i1 or Aliawtn+
It'
ADD 2 ex`tr('-
pirt5
H v

1 0 : 1�4576551
Name of Individual Applying For Permit: �2�6�/ e �I 1/1
f�
Address of Property,.
\lot or Street #, Street or Road)
(City and County)
'C
nSww-K
I hereby certify that I own .property adjacent to the above -referenced property. The inc
applying for this permit has described to me as shown on the attached drawing the developm,
are proposing. A description or drawing, with dimensions, should be vrovided with this 14
Y have no objections to this proposa;
It' you have objections to what is being proposed, please write the D+,1sirgn of (
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or cnil 91 j-79
within 10 days of receipt of this notice. No response is considered cite same as no objei
you have been notified by Certified Mail,
WAIVER SECTION'
I understand thata pier, dock, m,00ringpilings, brenlcrvater, bout house or boat lift tnus+
bck a minimum distance of 13' from my area of riparian access - unless wai",el bme,
Msb to ► aive the setbacit, you must initlal the appropriate blank below'',
I do wish to waive the 1 setback reauiren-,-r:
It it I I"-
1 do., n� wish to waive the 1 setback reausrcm _n'
5+tm Nam D` to
b�
Print Name
4r--."A

1 • ' �+57oSS1
Name of Individual Applying For permit: Q n�, F I , A-�14� J `�
Address of Property: (�
et or Strecc ts, Street or Road)
(City and County)
agyb��
I hereby certify t110 t I awn properly adiaccn; to the abovt.reiererc
r cd proper y. The
appl)'ittg for this permit has described to me as Saown on tht antiched drawing in a develop
are proposing. A description or drawing, with dimensions, should be crovided with thi,.
? have no ob'ec '
--�---- ) ttons to th.s proposa,
It' )you have objections to ,vilat is being proposed, pie -'se ► i-ire the Di � isiun di
Management, 127 Cardtnai Drive Xxtension, Wilm1no oh, ti'C ;8405 or c;rll yl o:
wirhio 10 days of receipt orthii notice. No response is considered the same as no ob
You hnve been noritied by'Cerdned Mail.
WAIVERS E CTIO N
I uaderstand that 1 pier, dock, Moring pilings, bratlnvater, bout house or boa, lit.r mr
bck a minimum distance or:5, from my area of riparian access - unless,► aired I m<
��isb to ►►ai.,e r!►e serbocic, you must initial the appropriate blarnk below.
: do wish to waive the l,' st:back reacire�,e
do rot 'A isn to wniv: the
Print Name -- �—
, I ACT, �--* ".5A k

NGENK
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director
Authorized Agent Consent Agreement
William G Ross it
M ` Ris hereby authorized to act cn my t
(Printed fame of Agent)
i order to obtain any CAMA permit(s) required for the property listed below. The authorization is limitec
�)ecific activities described in the attached sketch.
CCATION OF PROJECT:
v/0
20-y Ts . (\ - C
ROPERTY OWNER MAILING ADDRESS:
Y\ - C A -
PHONE NO."/- 2 -IV
,UTHORIZED AGENT MAILING ADDRESS:
�ffw-'icarl Wbrine- C�om+
� boa O 1 D &ID&C rd
SotA+kPc,r+ (W , 2$g6(
PHONE NO. 0111)_ q S ' SYEg
licnature or Property Owner: (g-

Division of Coastal Mgt. Habitat Impact Computer Sheet
(cant: K1 P (9A-i fJ
' 11 Sj� b S�f- 5� S
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
A in your Habitat code sheet.
tat 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
00
Dredge ❑ Fill ❑ Both ❑ Other ;9v
7—
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 ❑

THE AMERICAN FISH
o.
CHARLES H. OR KAREN Z C ERRY
P.O. BOX 11048
SOUTHPORT, NC 28481
f 1 ` i -
-:-. u�
First Citizens
Bank
fl
82647
DATE 66-30/531
453
—tculzens com _
.0 5 3 i00 300qpp 4 5 3 i 20 9 9 2 2n■
$ boo ,00
O L L A R S 8"