54551D - Ormsby

_rCAMA / '- ' DREDGE & FILL
lhENERAL PERMIT Previous permit#
New '--]Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources , ` f�
.oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /GG
` !! [34Roles attached.
t Name f d OYP2 Y Project Location: County �2 ✓ ••Sw �cllr
3 % ! l P J w ay c+ OI t/ P , '�[�G% Street Address/ State Road/ Lot #(s) AD LAU.0
—State /✓ L ZIP .Z
(ZOZ' 9 2-14 - 30 3S^Fax # ( )
ed Agent _SW el V ,, 141It NAM
❑ CW ;? V ❑ PTA _ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH __ UBA ❑ N/A
❑ PWS: ❑ FC:
yes (- PNA yes(42p Crit.Hab. yes / no
' Project/ Activity V1
a d d /v ew
-k) length
ier(s) 5 Y
ngth
Tiber
i/ Riprap length
distance offshore
x distance offshore
cannel
>ic yards
ip ryry
se/ atlift b
illdozing
/,0�7,0
Subdivision
City�c-Q fl.r .ems Z 2 OoAc h ZIP
Phone # ( ) River Basin 1 ylps
Adj. Wtr. Body( ,%/O t �J'r-� 01k/Z,% (nat /q
Closest Maj. Wtc Body— 1,oi
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❑ See note on back regarding River Basin ru

8x13ft. floating dock
�10ft.
I 4x16ft. ramp
5x4ft. off -set
12x12ft.
boat -lift
6x12ft. existing
8x12ft. existing
Ed Ormsby 10 laurinburg St. OIB N.C.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSI B pOATLI17TIBOATIIOUSE)
I hereby certify that I own property adjacent to Ed �- Qo b y j f . Svc A S `} 's
/ / (Name of Property Owner)
property located at /0 Lori V � V,y,V S�
(Lot, Blo , Road, etc.)
on _C►yae, in_ ( cArJ LS/%
'C �tAc� N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: A 1 7-SUO Mailing Address: U b 1;b1S0►� WU�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') 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 not wish to waive
X:-;� I do wish to waive that setback requirement.
- - -----------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-'Im461'e
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
OSOA) 6qv,&-
Mailing Address
z6379
City/State ip
6jis) 517-ICO
Telephone Number
•r
Signature
F Norris Sheppgcj � /1 t4a).16y
Print or Type Name
Telephone Number
Signature Date Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to EJ L Qo U L SV C (�r�S� 4 's
/ J (Name of Property Owner)
property located at /V
(Lot, Blo ,, Road, etc.) )
on _C t3 in V( esa:J LSI-,C -C arch N.C.
(Waterbody) (Town and/or County)
l � Applicant's phone #: 10)1777Sg36 Mailing Address: U 6 AdSd ),) Ale -
R-4X ',s � , d✓ c .2 E 3 71
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
(044S I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-------------------------------------------------------
(Information for Property Owner Applying
for Permit)
_�.,�0 t1�lSorl ✓�v�
Mailing Address ` / (
City/Star Ze iipp
6),s ) Sq 7 �83
Telephone Number
(Riparian Property Owner Information)
Signature
Print or Type Name
Telephone Number
Signature Date Date

-10-2007 08:49A FROM:VARNAM'S DOCKS&BULKH 9I0-75!,-6$71 T0:19198724826 PA
a
NO NR
North'Caroiins pepartment p�nvi onment apd N6tural Resources
Division of Cdastil Manogemerr!t
Achaol P. Easley, Governor CRarlas S. Joni, director William G Ross 1r , Secrerar
p
Authorized Agent Consent Agreement
t�t4- Ill MCIVQ✓ rYl
Is hereby authorized to act on my behalf
- (A'kWOd Nair 0 dAkanl.�..'..�..�.r....�.
)rder to obtain any CAMA perMit(gragLjtred for the,pro�erty listed blow The authorization is Limited to the
!icific activities described in the attached sketch,
Y .
1
CATION OF PROJECT:
DPERTY OWNER MAILING, ADDRESS:
q ,
.ter..--�.......1'.r ...�_ r....
pFjt?NE NO. �� so
rHORIZEO AGENT VAILINP ADDRESS:
q0.- qq
PHONE NO. � ,._.
14twre of Property Owner
o_
iaturo of Authorized Agent:; ��-----�

-ant: 61Z
Permit #:
,ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
i in your Habitat code sheet.
:at 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/o
temp impact
amount)
�j✓
Dredge ❑ Fill ❑ Both ❑ Other X[
2
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 ❑

VARNAUIS DOCKS & BULKHEADS INC
1574 MONSTER BUCK ESTATES
SUPPLY, NC 28462
910-755-6861
TO THE
ORDER OF
�„ t7Yl,-�N%� Glf �' U�% � CSC • ((
BRANCH BANKING AND TRUST COMPANY
1-800•BANK BBT BBT.c0m
FOR = ��I• 5�551 �' LL2L�:00052L5792$7
1100000 6 31 2 3"m i:0 5 3 10
DATE L—/