54518D - Minopoli

1CAMA / ❑ DREDGE & FILL ti
aENERAL PERMIT Previous permit#
JNew ' Modification El Complete Reissue El Partial Reissue Date previous permit issued
razed by the State of North Carohna, Department of Environment and Na
Zoastal Resources Commission in an area of environmental concern pursu
it Name J-05�-Pq M 1 Qo PGu
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State .PR
ZIP 194 74
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ied Agent
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❑ CW
ItW
[,?PTA
❑ ES
❑ PTS
❑ OEA
❑ HHF
❑ IH
❑ UBA
❑ N/A
❑ PWS: ❑ FC:
yes /,'no PNA yes /. no Crit.Hab. yes / no
tural Resources
ant to I SA NCAC L v
ules attached.
Project Location: County bx i j 1W IC-4C
Street Address/ State Road/ Lot #(s)
1U� E. 6L�� p2.
Subdivision
City o—y- ZIP 2
Phone # ( ) River Basin
Adj. Wtr. Body LJR,t� A iS ; fnvAl (`t F
Closest Maj. Wtr. Body
f Project/ Activity 1 IN- 517V1 1, iyCV\J 11 k 1 d LC i L I CIE
(Scale:
xk) length
n(s)
)ier(s)
mgth
amber
id/ Riprap length
g distance offshore_
ax distance offshore
hannel
bic yards
lip
Js��f W x 1 o`
lulldozing
ie Length ti �QI
not sure yes Po
,s: not sure yes no
^ium: n/a yes no
yes no
Attached: yes no
ing permit may be required by: V F11,- I D16- Phy+J Ll See note on back regarding River Basin ri

(b
IE-
American Fish Company
P.O. Box 11046
Southport, North Carolina 28461
Email: [e-mail]
n
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a
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Front P. ►-
INVOICE NO #
(910) 457-5
(910) 457-6

Michael F Easley, Govemor
iNLUEANK
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
James H. Gregson, Director
Authorized Agent Consent Agreement
William G Ross Jr.
is hereby authorized to act on my b
( (Printed Narf of Agent)
order to obtain any CAMA permit(s) required for the property listed below. The authorization is limitec
)ecific activities described in the attached sketch.
JCATION OF PROJECT:
©% F-. X,Sl&vkb T>f-
-ih t 1 v'i S Cc4)aL
'. ce N 4 TDSr PIAirJd� I'"(i No PcLi
ROPERTY OWNER MAILING ADDRESS:
0 1 1 Ltci bri. ve.
To. Gox 13�
PHONE NO %0 l�� `J - 80 5
JTHORIZED AGENT MAILING ADDRESS:
Lrn�l��Zl C on'5+
5�c'r r D
1 c, rQQrA _C--
PHONE NO. C110 - Lj 4 Ll
gnature of Property Owner

- � '
Name of Individual Applying ;~ or Permit, ,�� es e P � M „A� I �
Address of Property-_,-T---,, 1an
,Lot or Street g, Street or Road) _
T<
i�iand County)
h�C
1 hereby certify that I own property adjacent to the above•refcrer.cea propc,-`. The in
appl�?ing for this permit has described to me as shown on the a1mched drawing ;,7c d~eveloprr
are proposing. A description or drawing, with dimensions, should be c►ovide 1 with this
r
��.ecKNe c :have no objections to this proposfl:
11' you have objections to what is being proposed, please write the Ui�i;;.:;, of
Management, 127 Cardin;tl Drivo Extension, Wilminotorn, :NC :8405 or call yl •7s
witbia 10 days of receiptofthis notice, No response is considered the some a: no objt
I
have been notified by Certified Mail,
WAIVER SECT.iO '
1 understand thnt'a pier, dock, Mooring pilings, brenlovater, boat mouse or boa; ;ifc mu:
bck a minimum distance of 13' from my area of ripnrion access - unlessaiv ea DN me�
wisb CO waive the setback, you must initial the appropriate blank
�Ftrc i do wish to waive the 15' setback recuirP-.-.
RC -� 1 d0 not -, ish to �V�Ivc the 1? SCtl77C1{ ."Ca'.;ri �-
��- .ram /b
rtwn�' S+ rme Data
pent Name. �,�

10:94576551
Name of Individual Applying For Perrrft .�. �5�P H M i �a:Po (i
Address of Propert},. T S �CL11D 'p r-
,Lot or Street 0, Street or Road)
(City and Counry)
I hereby certify that I own property adjacent to the above•referercea property. The in(
appl)lng for this permit has described to me us shown on the attached drawing the developm
are proposing. A description or drawing, with dimensions, should be vrovided with this 1,
�hecK<rc �/ have no objections to this ro osai
1 p P
11' you have objections to what is being proposod, please wrire the Division of (
Management, 127 Cardinal Drivo Extension, Wilmingron, ."N'C 284OS or call 910-19
within 10 days of reeoipt of this notice. No response is considered the same as no obje
you have been norified by Certified Mail,
WAIVER SECTION
i understand that a pier, dock, mooring pilings, brcnl0vater, boat house or boat lift tnus
bck a minimum distance of 15' from my area of riparian access - unless waived' by me,
wish to waive the setback, you must initial tho appropriate blank below,;
r
�1erc �
-� luad�-
9wnta�x S+un Name
do wish to waive the 1 sc:bacic reaLirer--V7:
I do not Nish to waive the 1 setback requirem?r;
Date
Print lV�tme ,�`�"�'�

Division of Coastal Mgt. Habitat Impact Computer Sheet
icant: ' Tn 1 N QPQ L 1 J3-V S&R O ii I r ir,5451 b
1lisli n
gibe 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 Tina
disturbance.
Excludes any
restoration and/c
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other )9
110
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 ZC ERRY
P.O. BOX 11046
SOUTHPORT, NC 28481
In,* u'k—'
First Citizens
Bank
firatcluzens com
82647
DATE 1 J 66-30/531
453
11'08264?uo ':053100300i:00453120992211■
$ �00.00
DOLLARS 8