54576D - Mendis

CAMA / ❑ DREDGE & FILL 54
GENERAL PERMIT Previous permit #
1Nevw ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ` �C �'
QRules attached.
S
t Name`y 1L N�� �k Project Location: County !ilk l N l.y i +
State_ ZIP
IT4ax # ( )
:ed Agent- 0 tV PUP- V•- i( f*) LASd . CO .
❑ CW G4,EW Q PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Street Address/ State Road/ Lot #(s)
Subdivision
City ( A 1 L I SL f1-6 ZIP
Phone # ( ) River Basin'
Adj. Wtr. Body k
❑ PWS: ❑FC:
Closest Maj. Wtr. Body
yes / no PNA no Crit.Hab. yes / no
es
f Project/ Activity i�1kLL w-K1/�,�E;.jSTI{V� I LIFTS
(Scale:
li
,ck) length
n(s)
t 2 x
)ier(s) � i � � 3 1 � S'
.ngth
amber
id/ Riprap length
g distance offshore
ax distance offshore
hannel
ibic yards
mp
use/ Boatlift
3ulldozing
'!
=N:•
ne Length '59I
not sure
yes
gs: not sure
yes
rrium: n/a
yes
yes tTl
Attached:
ni
ling permit may be required by: OA� I S L 1J09 ❑ See note on back regarding River Basin i

American Fish Company
P.O. Box 11046
Southport, North Carolina 28461
Email: [e-mail]
?SS
INVOICE NO. #
(910) 457-54E
(910) 457-65!
20
DLD BY
CASH
C.O.D.
CHARGE
ON ACCT
MDSE RETD.
PAID OUT
ANTITY
DESCRIPTION
PRICE
AMOUNT
'hj I' 3 3
v►
�'x ts` �i �
4Px; 5 ; nG t 1+ "
I
�
Q
400*
d
�_
I

NT
• r P 0 . ICAT N/WAI R FORM
Name of Individual Applying For Pern%it: ,,&A U.
Address of Property: •3 3 07 <C�:t
(Lot or Street #, Street or
(City and County)
Jr.
CO-
I hereby certify that I own property adjacent to the above- referenced property: The indivic
applying for this permit has described to me as shown on the arched drawing the developmenO
are proposing. A descrlption or drawing, with dimensions, should be provided with this Leiter
I have no objections to this proposal,
f you have objections to what is being proposod, please fvrite the Division of COR
Management, 127 Cardinal Drivo Extension, Wilmington, NC 28405 or call 910.796-1
within 10 days of receipt of this notice. No response is considered the same as no objectia
you have been notified by'Certiiied Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, brealovater, boat Douse or boa: lif•tmustb(
bck a minimum distance of 5, from my area of riparian access • unless waived by me. If
wisb to waive the setback, you must initial tho appropriate blank below,)
4-- I do wish to waive the 15' setback requiremen,,.
I do not wish to waive the 15' setback requirement.
�1 y �b
Sign Nara \ j� Date
V
Print Name

'Name of Individual Applying For Permit: LILL t4 D L
Address of Property: C)S FE,_s4 tct ,ch'r �
(Lot or Street #, Street or Road)
(City and County)
r kA=WrCK
I hereby certify that 1 own property adjacent to the above -referenced roe The individuf
ppl} ing for this permit has described to me as shown on the attached drawing the development the
are proposing. A description or drawing, with dimensions, should be provided with this letter.
CkttK I have no objections to this proposal,
It' you have objections to what is being proposed, please write the Division of Coasta
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-721.;
within 10 days of receipt of this notice. No response is considered the some as no objection i
you have been notified by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakovater, boat house or boat lift must be sei
bek a minimum distance of is' from my area of riparian access - unless waived by me. (if you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement,
I do n9c wish to waive the 15' setback requirement.
Si N, c ) Dace Print Name �,,�

. AMCsWw
�i
' 1%
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F Easiey, Governor Charles S. Jones, Director William G. Ros-
Authorized Agent Consent Agreement
IprYi PAY' is hereby authorized to act on m
rinsed Name of t)
in order to obtain any CA permits) required for the property listed below. The authorization is limi
specific activities described in the attached sketch.
LOCATION OF PROJECT:
3363
E
Vach+
Oct
d
, N c aL1L�5
PROPERTY OWNER MAILING ADDRESS:
R " In t.( [Z-0 — M ej ��'
0u'Ll- T7s ICU -6 , N
AUTHORIZED AGENT MAILING ADDRESS:
3c�uc� old ricjae �I.
Sou4-hpoE± Nc q& I
PHONE NO. 9 19 56� —7^ ` 6
PHONE NO. 11 v— 4�1 �~ 76
Sianature of Pronerty nwnPr -1l hVkxl Ai

Division of Coastal Mgt. Habitat Impact Computer Sheet
icant:. M.aJ01S 0 jLG'
I� -�/l0
f2tK,*�, i T fll�- SL+S7(O
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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)
O Q
Other
Dredge ❑ Fill ❑ Both ❑ �
J
Z
Z
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 ❑

HE AMERICAN FISH
o.
CHARLES H. OR KAREN ZC ERRY
P.O. BOX 11046
SOUTHPORT, NC 28481
DATE J `—S — 0,�,
First Citizens
Bank
first 101
82647
66-30/531
453
$ �00 ,go
.DOLLARS
c zens com
GP5ta
II'08 264 7u■ i•
.0 5 3 100 3 0 01.00 4 5 3 i 209922,11 __------- _