55831D - Prestage

CAMA / DREDGE & FILL
ENERAL PERMIT Previous permit #
New C)MQdification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by tie StateofNorth Carolina, Department of Environment and Natural Resources
Coastal Reso rces Commission in an area of environmental concern pursuant to 15A NCAC
Rule attached.
t Name ''i K b1 -6 L Project Location: County V 1
45 V I 1 ILI Street Address/ State Road/ Lot #(s)
StateNc ZIP v -�g L N . A ndi ► ax 1 vd .
2,Fax # ( ) Subdivision N R
zed Agen tia V `� / City1 , eQ ck ZIP �Lfl
l ri '
❑CW �( XPTA ❑ES ❑PTS P 1 5r (IL( ) Q - C 3(P River Basin a
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body ( nat
❑ PWS: ❑FC:
yes I /no PNA ye Clno Crit.Hab. yes / no Closest Maj. Wtr. Body A L�
Project/ Activity
Jock) length
rm(s) (� �—
pier(s) t(� x Z+"
length
camber
Bad/ Ripraplength
Ivg distance offshore
nax distance offshore
channel
:ubic yards
amp
ruse/ Boatlift
Bulldozing_
ine Length
not sure
yes
no
igs: not sure
yes
no
xium: n/a
yes
no
>.
yes
no
r Attached:
yes
no
j17
(Scale: ` s /
Jing permit may be required by: rl
1, j ! j ,� 1� `r 1 ❑ See note/ on back regarding River Basin
I I'�1 wl All RYI. r.i If,76 1 ('LL ai i A 1 i/i t I.J.r.1 i w I—, i n

irrcENR Resources
North Carolina Department of Environment and Nat
,ural
Division of Coastal Management William G. Ross Jr., s
:hael F. Easley, Govemor James H, Gregson, Director
Authorized Agent Consent Agreement
r-be)c �,07- is hereby authorized to act on my bel
(printed Name of Agent) listed below. The authorization is limited
rder to obtain any CAMA permit(s) required for the property
;cific activities described in the attached sketch.
,CATtON OF PROJECT:
l�loLY-05oil vd.
ROPERTY OWNER MAILING ADDRESS:
PHONE N D '
,UTHORIZED AGENT MAILING ADDRESS:
PHONE NO. 2-T
:innature of Prooertv owner

DIVISION OF COASTAL MANAGEMENT
UAN PROPERTY OWNER NOTIFICATION/W
Name of Individual Applying For
Address of Property: C (�. / voice
(Lot or Street #, Street or Road)
- -- - - - (City -and founty}
I hereby certify that I own property adjacent to the above -referenced property. The individ
applying for this permit has described to me as shown on the attaehed drawing the development t1
are proposing. A description or drawing, with dimensions; should be provided with this letter.
4 �rck�5 - I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coas
Manauement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7:
within 10 days of receipt of this notice. No response is considered the same as no objectio.
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If
wish to ivaive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
1
/ O
Sian Name / ate
.. r C
Print Name
©0

DIVISION OF COASTAL MANAGEMENT
PDIACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property:
5 18" C. nao2z
.- "Derc-S 0 PJ
(Lot or Street r, Street or Road)
-Kn P<4q`l '--24- nJ C
(City and County)
2_9 (-(-(1
I hereby ce—,,ify that I own property adjacent to the above -referenced property. Tate irdivi-?u
apclving for this permit has described to me as shown on the attached drawing the development th(
are proposing. A description or drawing, with dimensions. should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed. please write the Division of Coast
ive Extension. Wilminaton. NC ?8405 or call 910-%95
Management, 127 Cardinal Dr
within 10 days of receipt of this notice. do response is considered the same as no objectior
you have been notified by Certified ;tilail.
WAIVER SECTION'
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
bck a minimum distance of 15' from my area of riparian access - unless -'waived by me. (If
wish to waive the setback, you must initial the appropriate blank below.)
Si -in Name
I do wish to %vaive the i setback re:,uire:Mnt.
I do not wish to waive the I5' setback requirement.
Date
Aiw e

V�lt/�1'�i -aw.crr>>l
NlbCXI'1 IP1wo1A
Lf rail

ID Division of Coastal Mgt. Habitat Impact Computer Sham Cf 5S � 31
ate: `
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet. t FINAL Feet
I DISTURB TYPE
Habitat Name Choose One
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 ❑
DV]o
d❑ Fill ❑ Both ❑ Other ❑
ll ❑ BothEOther
ill ❑ Bot
ill ❑ Botill ❑ Botill ❑ Bo
Fill ❑ Both ❑ Other ❑
TOTAL Sq. Ft.Lrb
for.
. Ft.
d final
Fee
for.Lntednd
final
(Applied
Disturbance totalnce.ncee.includes
any
anyudesanyanticipatedtion
pate
L
andlorestoration
octtemp
orempon
impactsountacts
I\�(A
)LIH

DELTA DOCK & BOAT LIFT
402 AQUARIUS DR. 910-686-9700
WILMINGTON, NC 28405
OF
8164
/
66-30/531
DATE 365
$
DOLLARS
First Citizens
Bank �P 5510 D __:
008 L64u■ i:053 L00300t:00353 L99 L5041'