55854D - Saintsing

AMA / DREDGE & FILL r- I
E N E RAL PERMIT Previous permit #
-'K]ew Modification [-]Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources //
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC '714 ,12 6 0
C4Rules attached.
nt Name c�/// �.✓ �Si � Project Location: County �/�Qu.v fct/ � C
Z/ 7.5 C— Street Address/ State Road/ Lot #(s) -Pe
61 le!G State ZIP (o /S
hOFax # ( ) Subdivision
zed Agent
❑ CW EW CNtOTA
❑ OEA HHF ❑ IH
❑ PWS: ❑FC:
/
city 0(- Zr oAc� zip 2
�s ❑ PTS Phone # ( ) River Basin 44,*
❑ URA ❑ N/A Adj. Wtr. Body e4'-'A 0-7 - Al tyz✓(na
'4/ Z" w
Closest Maj. Wtr. Body
yes / no PNA yes / ® Crit.Hab. yes / no /+ 1.
A Project/ Activity )9 A) (-✓ 3v'0�Li-f � �(� �x � 51...
,c r S A.,.f /- L. A t ,. , -2), (Scale: � =
lock) length ll l5 -f"-M_ T N
-m(s)exiS'%in F71/1%i TTT-1
I I
_`
length
,umber
:ad/ Rip
vg dista
iax dist
channel
ubic yar
imp
WWI,
Bulldoz
ne Length Jy
not sure yes
i
(no
cgs: not sure yes
olio
)rium: n/a yes
/fio
yes
�60
Attached: 60
no
ling permit may be required by:
❑ See note on back regarding River Basin
, _-, -- - . - _ I

Fax Server 7/16/2010 11:42 PAGE 3/3 Fax Server
JLL-16-2010 10:57 FROW MARITIME BUILDERS 9105458222 Tn:19192502211 P.3/3
A FM
CTMA
North Cardin Department of Environment and Natural Resources
Division of Coestal Management
Beverly Eaves Perdue dames H. GMoo Dee Freeman
Governor V*tur Secretary
AGENT AUTHORIZATION FORM
Date:? !Q
Name of Property Owner Ap*ing for Permit:
MaWng Address: T / J�af `-
Phone Number:
I certify that i have authorized (agent) ��2a Zaa -IN to act on my
behalf, for tho purpose of applying for and obtaining all LAMA Permits necessary to instag or
conatruct (activity)
at (rny property located at)
Date
9

Fax Server 7/16/2010 11:42 PAGE 2/3 Fax Server
JU.-16-2010 10:56 FROM: MARITIME BUILDERS 91054SM22 TO IMMSOMII P. 2,3
e'-f: Hed tx '.I-
Ck;R'I'IFIED MAIL —RE'I M-NRECEIPT REQUEMI)
DIVISION OF COASTAL MANAGI•r A]ENT
AD, A(MNT RVAR AN MMER'x Y OW14ER STATENRINT
Name of Property Uwacr:0-4 t
Address of Property: _ �_ ©,i? rl� /5r�tctJGtNSWrG� �v�
(Lot or Streettl, ShworRoad, City & County)
/f75 7 5�d p;,li,w LL.
Applicant's phone f: �f /� }� Mailing Address:
/ . �4 'vc/s-
I hereby codify that I own proporty adjaeont to the aboves eefercnccd Property. The individual applying for this permit
has de sorilml to me as shown on the attnchod drawing the development they are proposing_ &dogipgon of tin► "
M 'OL dimensions, must ba provided withthis JMr.
�C> ` have no objections to this proposal.
I have objections to this proposal.
I
19W If you have objections to what is being proposed. you must notify the Division of Coastal Management (D CDC
AN- in Writingvrlthiu 10 flays of rtceiptof this notice. Correspontlence should he mailed to 127 CardinalDriveXri.
Wilmington, NC 28405-3845. DCM representatives calt also be contacted at [phone]. No response is
consid rend the same as nob on ' u al
WAIVER SEMON
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
15' *om my area of riparian access unless waived by me. (Ifyoa wish to waive the setback, you most initial the
appropiJate bieutic below.)
I do wish to waive the 15' set back requirement,
rmHRp I do not wish to waive the 15' set back requirement
R�
(ProWrty Owuer Information)
A .Y s-� - -
t .
Print or Type Nam L �1
Mat'ling A�dt+ess
Nnlstjetv-'�Izip
Prim or Name T_
75- 7 5��.os e Z,,
Mee
City / State/ Zip

qb)u' wc-- -
ADJACENT RIPARL46N PROPERTY OWNER STATEMENT
(FOR A PIERMOORIM PSG&BOATL 1R0A3".8'OIISE)
I hereby certify that I own property 4acent to-, ' 4(/) SAP lt7 y 'S
k_'ame of Property Owner)
property located at
(Lot; Block Road; etc.)
ffaterbody) (Town and/or County)
Applicant's phone : 1 �� ���I I4lafing, Address: 4Z?57-5A&A)05' DiCP .
He has desenbed to me, as shown below, the development he is proposing at that location, and,
have no objections to his proposal- I understand that a pieemooring pilings I boatti$1 boathouse
must be set back a minimum distance of fifteen feet (IS) from any area of riparian access unless
waived by me. (ifyou wish to wive the setback, you must initial the appropriate blank
w1ow.
_ I do not wish to waive
'1
do wish to waive that setback requirement.
DES MMON AND/OR DRAWING OF PROPOSED DEWLOP_MENT:
(T`o lie jWed in by iadfvidual proposing development)
(Information for Property Owner Applying (Riparian Property Owner information)
.for Permit)
%icing Address
2-715,
citylStatetzip
signatire
r�
Print or Tvpe Name

4
0 e
�J1

cant: �y'fd,'l ��i�✓si
?/ wo
Permit #: S-Fri y
:ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d 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/oi
temp impact
amount
/
t!N
Dredge ❑ Fill ❑ Both ❑ Other
2
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 ❑

MARITIME BUILDERS, INC.
77 CONCORD ST.
OCEAN ISLE BEACH, NC 28469-7633
E J
� OF l/
ankofAmerica
i�I R/f 053000198
ill n - 1 ,r,.-- -- -
12-06 2120
DATE 66-19/530 NC
2210
OLLARS