54480D - Melton

CAMA / DREDGE & FILL
E N E RAL PERMIT Previous permit #
New _Modification - Complete Reissue El Partial Reissue Date previous permit issued
prized 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
` Rule Attached.
nt Name 1 Project Location: County �S b '1
I'. L.) - 16A Z�S(n 2 Street Address/ State Road/
Lot #(s)
%Ya State_ ZIP o
� (!, ) - Fax # ( ) Subdivision ClN IA
zed Agent _ _ City —✓-� U4-il ZIP
1 Cw PTA --ES PTS Phone # ( )C'.rGl f1�E River Basin
OEA ❑ HHF IH ❑ UBA ❑ N/A I '
Adj. Wtr. Body Y�1 GI,V�V1�aG� r COl V1G� (nat
Pws: rn)o
yes / no PNA yes Crit.Hab. yes / no Closest Maj. Wtr. Body
Project/ Activity
lock) len�th
rm(s) X
length
lumber
ead/ Riprap length_
ivg distance offshore
nax distance offshore
channel
:ubic yards
amp
Ouse/ Boatlift
Bulldozing
ine Length
7
not sure
yes
no
igs: not sure
yes
no
Drium: n/a
yes
no
`. ye no
Attached:
C` yes
no
(Scale: ) '-:
ling permit maybe required 1by:` Y � U ❑(
See note on back regarding River Basin
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DIVISION OF COASTAL MANAGEMENT
UAN PROPERTY OWNER NOTIFICATION/WAIVER F
'Name -of Individual Applying For Permit:
Address of Property:
( r Street # Street or Road)
't
(City and County)
-J_
il
I hereby certify that I own property adjacent to the above -referenced property. The indiN
applying for this permit has described tome as shown on the attached drawing the developmen
are proposing. A description or drawing, with dimensions; should be provided with this left
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of C(
Management. 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796
within 10 days of receipt of this notice. No response is considered the same as no object
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must
bck a minimum distance of 15' from my area of riparian access - unless waived by me.
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 1 5' setback requirement.
416 S_ _ -
Sign Name Date
S sell L �► ��> -� �� �_
Print Name �r ;

1J1r LQL\l1y vl '.,Vft3 Ltt-L 1y1tS141-1%,J1.:1yLQN L
RIAN PROPERTY OWNER NOTIFICATION
2me of Individual Applying For Permit:t
Address of Property: Ag6 3✓�qt.
(Lot r Street rr, Street or Road)
Ci k
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The indivi
applying for this permit has described to. me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lets
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co
Management. 127 Cardinal Drive Extension, Wilmington, itiC 28I03 or call 910-796-
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAItiER SECTION
I understand that a pier, dock, mooring pilings, breakwater. boat house or boat lift must 1
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (1
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 1 5' setback requirement.
y/PIa
Sian Name D to
/L ./ • 7EN i��Z/C
� �C S
Print Name

ID Division of Coastal ?Agt, Habitat Impact Computer Sheet
pplicant: ka� I Permit#:ate: / "`{{{��ili�lq
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
wnd in your Habitat code sheet.
abitat 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/c
temp impact
amount
1
W O
Dredge ❑ Fill ❑ Both ❑ Other g
' W
' W)
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 ❑

HUY NICLI Vlv
BONNIE MELTON
NCDL 20634 121611
3055 THIRD STREET PH. 910-389-9452
P.O. BOX 2862
SURFS CITY, NC 28_345
PAY TO THE
ORDER OF_
DATE
O�
_ RBC Bank'
r RHC Bank (USA)
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