54563D - Phillips

CAMA / DREDGE & FILL
ENERAL PERMIT Previous permit#
New Modification Complete Reissue Partial Reissue Date previous permit issued
orized by the State ofvJorth Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 4 H , I66 A.
Rules lath
nt Name I`JU 1 'LProject Location: County
s Street Address/ State Road/ Lot #(s)
_;tblSV1�i E' StateNC ZIP �g3 Q, —
,,1i, }�
# ( ) (, �J tG Fax # O Subdivision
ized Agent vYel i �j/i1�1 /� G ; �gt ►" Ay)ttt City ZIP �y �
d CW EW PTA ES ? C PTS Phone # G ) - River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body 1 Yi1 Vk nat
yes no PNA yes no Crit.Hab. yes / no Closest Maj. Wtr. Body r � �
❑ PWS: ❑FC:
lof Project/ Activity
dock) length IV "' l0
rm(s) W- n l � —
pier(s)
length
number
lad/ Riprap length
ivg distance offshore
nax distance offshore
channel
:ubic yards
amp
Ouse/ Boatlift
Bulldozing
ine Length ---�-�
not sure yes
cgs: not sure yes
)rium: n/a no
es no
Attached: yes no
Y
`J (Scale: ( "'=
ling permit may be required by:
iAl
❑ See note on back regarding River Basin i

FAX NO. Jun. 07 2010 08:32AM P2
e
,5S' S C,40 wv !"II

FAX NO. Jun. 07 2010 09:33AM P3/
i
r
dame D� _= i�-idual AD jyiag For ?e��
Andress Of ?rodarty:
Z�
(Lot or Street',
f X I
or Road, Ci=Y.& county)
I hersby
=E miry
that I own nra�r-"v ad • 3c8
J u. tohz
referenced To
P- pe=-ty • The S.nc}i�rid al applY'�S for r_tis
aacsve-
hermit has
described
to me as
shown on the attarhld mowing the
deveiormeut
6-hey
should b-
�roDasing.
p avided
A descx'iatzcoa or drawimg, with
with this
dimensions,
letter.
I have
no objections to th S P-=posal.
C
P
G lq
�T
I =de stazid what a pier, a�
ii:se D= -1,20at lift =ust he set
G »:. e_"' An 8c^eSs - tt�Iess ar i*�rac� by =a. wi5h ;.a
eve the sa�:bac"s, you must : Zi tl the azrpr=p+::ate b.? ami:eio�r. ?
7 do wi5b to waives the is setba„
"k=aq -L-=T-�QiC!,.IIt .
vaas to wa=va the z'� setbacl: r qua =nt,

ta.
• aaia{ i�'i ate i �T _ F = Ad C
u
'ir- :an aq w_oom #M 311 n
'�t� i=r 'R44fIS� a—rzocw "fir oo ' sal►u R :S1,q L
�sI=lm
A rk
y_
4,� B�Dxa:Bt CtT ihR� d4�
3'p �� '�M�Os7 sb �3:a'�r�p �F '�"rsfladO�►! wSs, JGsq�
t $ at Le'&M=1 a tqn ff© cweGa nt 44 0% X
sas; :%Tmsad sr a. rrr� get- ��c�t C P + GX .<1. ps p4t'aa�ees x.
wp41,qv srm oz sxerp�r .{sf3 Cuhq I �= aR�
F--zwqw-.,B ale- FI Fgt
ibd wu2z :80 OTBZ Z0 'unf : 'ON XUA

FAX N0.
Jun. 07 2010 08:32AN P114
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal )Management
Michael F. Easley, Gcvemcr James H. Gregson, Director William G. Ross Jr„ secretary
Date
Name of pro erty Owner plying for Permit:
� xr
Mailin Address,
Po -T-9ej --s—/e`
I certify that I have authorized (agent) �� Cis A�Aeo act on my
behalf, for the purpose of applying for andobtainingall�,C/JANM Permits -necessary to
install or construct (activity) e U 19n e� /" 1 e r—, 6 /* 7, e-i 4 ,
at (my property located at) 'Cl
This certification is valid thru (date)
�"'s 0,00
Property Owner Signature
-'�- " -Ab
Date

aC Di�vist'i n of Coastal Mgt.
r Vim"
pplieant:
ate: I
V)`��Io
Habitat Impact Computer Sheet
Permit #: '545(a3 j
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
)und 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 fir
disturbance.
Excludes any
restoration anc
temp impact
amount)
Dredge ❑ NIX Both ❑ Other ❑
55
5S
w
Dredge ❑ Fill ❑ Both ❑ Other
Li
Dredge ❑ Fill ❑ Both ❑ Other
a
I
W
Dredge ❑ Fill ❑ Both ❑ OtherA
a
oC C
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 ❑

LIGHTHOUSE MARINE CONSTRUCTION INC. of-lo
P.O. BOX 2532
SURF CITY, NC 28445-0028
DATE
PAY f�
TO THE OR le
ORDER OF
,--'7C.
Bank ofAmerica
"!I
/J ACH R/T 053000196
11.00379311' l:0S3000L96l:
6 —14 - (O
2 3 700 Sit L S88 ?III
3793
66-19/530 NC
702
BARS s....„
V W

C,P6�I�to4
ADJACENT PROPERTY
STATEMENT OF
RECE'll rt
MAR 092010
NO OBJECTION DeM
N
I hereby certify that I own property adjacent toFrat-le'% T�t• 1� , lli( _Is
(Name of Property Owner)
property located at
on A-Vinn-IiC. in Surf City, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),
the development he is proposing at the above referenced location, and, I have no
obo-ections to his o osal.
JC7/ -
Siature Phone Number
Print or Type Name
Date �317
Return form to:
NC DIV. OF COASTAL MGMT
1 n'1 /' A Tl 1\TX T A T T IT