54567D - Surf

CAMA / DREDGE & FILL
"ENERAL PERMIT Previous permit#
New ' uModification uComplete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
(( l , Rules attached.
Name 0t Project Location: County w
r•�X Street Address/ State Road/ Lot`#(s)
Vt State NC. ZIPAHq (,iaioA kaA �')�twun 1'AVIA Z* St
)� A-91}a Fax #( )
A Agent b k ]VA C6(SS1�
CW ❑ EW ❑ PTA
❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
fes / no PNA vest**/' no
Project/ Activity
length
F pier(s)
length
number
T
ead/ Riprap length
tvg distance offshore
-nax distance offshore__
channel
:ubic yards
amp
ouse/ Boatlift
X 10
ine Length
not sure yes no
ags: not sure yes
orium: n/a yes no
yes no
r Attached: yes l "
ling permit may be required
P�ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Subdivision
Phone # ( ) �IYkP
Adj. Wtr. Body
--�—
Closest Maj. Wtr. Body
ZIP LL
River Basin
V
tV-ha V&
(Scale: I
MAS low Uourrft❑ See note on back regarding River Basin
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£"" - '••y' �_ , r UWNER ICATION/WAIVER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Mana9L1menr confirmation that a written statement has been obtained signed by
indicatng That they have no objection to the proposed work or that the ad scent the adjacent riparian property oers
'�v certified mail of the proposed wont. Often these forms are submirted o the adjacent riparian Prproperty operty owners by aTr
;ontractor or other individuals acting as an authorized agent on behalf of the applicant, p p
phis form was sent to you by the following individual or cor�tpany designated by the applic
uthorized agent: ant as an
!
'7b
uthos, Aaenr's Signature Daze
acne of Individual Applyiba For Permit:. ct, C. .
dress of Property: �llk C.4Z,
(Lot or Sr_5e:.=. Sheer or Road)
� �AF cry ^- C,
City and County)
sreby� certify that I own property adjacent to the above -referenced propem. The individual applying for this permit
:described to me as shown on the arrached drawing the development they are proposing..'_ description or drawing.
l -dimensions, should be provided with this letter.
I have no objections to rhis proposal.
'OU have objections to what is being proposed, please write the Division of Coastal Management. 127
elinal Drive Extension, Wilmington, �; C 28 Os or call 910-796-: ? i-4 within 10 days of reeeipt of this notice.
response is considered the same as no objection if you have been notified by Certified Mail.
W AI"VER SECTION
:drstand that a pier. dock. mooring pilings, breakwarer, boat house or boat lift must be set back a
imu€�s distance of Ij' from lily area of riparian access - unless waived by me. (If you wish to waive the
ack, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive tj e 15• setback requirement.
/J,*-
Date

—
Fpose oT t —__-
diis �o37"f - -- _
7iCtii�il2.[S listed betaum, j �° provide �"�-- t •F` _- __—
PFo Ji%z
rop„ti �•f -ire t-•1� I%`1rOtiC' r ATic'
ea�etlfenr L " IV' General0 3*ot! a, a,; - R I✓CiF
?d1Ca rc hai they nave tiG'' kr'Or rhaF g e 1 j�r1r 8tlnlfrsiu�ti4 �i 449Lr�$ i�Lnan r4�e G}
rzifred rta'3 r oolecrion to ;,hc eliieq` has cI°raine t ui e t a
or r;le proposes �: propose oz or , c sia e� , �pN�)i, 4
lncra- d . y. the
C]s Qdaop F"WvA:! did ac.rmg as authrh� F' zT?S e" :hat the adiacear _iOarian adjacent �P$riaix
O' 2 Q t3g%,Zr QP 40 ��Jl�i `n A41- q',�a►_Vm
iF3 for
-r 'Wof the applicant,
^ram, as sent to you by t
-��—V— b ✓�r!!/,Jim - raa fliols v iiE£�I ,dlP�t or coraDan 4ae taarod br the ss ttss., M
e of Itls3ividua! -` pPkving For Per r,i,
(i..or or Srr C . `VreLL - -�-
o,- Road,
�. O �c0 w
tCi airs "aunrvs
u cerrif� Char i ov !t propem actjacen: _o 'sIre acot e-refcre lce 7 oro e Tv.
cri es to !-'e -q s Own on the at`rached dl-awini r.he s�� ` p The :zdiv?dual app ti irl for his permit
Mons' "s, sh e - �vl7ri e lril?e are }irapOsiP_a. A- }desc Dtion ordrav incr
Auld b� prcvided u�•ith this Ierte=.
I have no al jeeclOns ro EhILpro.posal.
have objections ro w11ai is being proposed, please write the Division �_-. ision of Coastal 'VIanagernenr. 127
ai 3Dniv€ Extension, ��'illina;aei, N i 28405 of c2JI 910- 79b- 72 -r_v within !Oda s_pgipj of this nonce.
00se is considered the same as ao obie-tiOl? if You have been notified b;• (--r- `hart 'vinri
Viand that a pier, docn„ mooring pilings, breakwater, boat house or boat h zest be set iiac� a
m distance of 5' f om lazy area of riparian access - uniess waived by me. (If you wish to waive the
you must initial the appropriate blank beio .)
waive i do wish to ive the 5' seLbac4_ requirement.
� C}} teITicilr.
i L?J at Wish to waive tlrti .?t setback re6uiemenr.
a' ENR
-MCE)
N-1--N C•* Cd_ CF
LNI ``iJfikl' sa.0 :C.T/a. QCE�t.:C.L

b., � FP sao
R%VCNK
Noah Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley. Golrernor James H. Gregson, Director William G. Ross Jr., Secretary
Date / 'YT"" /sue
Name of Property Owner Applying for Permit:
C/Z7
Mailing, Address:
/'0' gzz
I certify that I have authorized (agent) 46"" C4,U la to act on my
behalf, for the purpose of applying for and obtaining all CA14-1. Permits necessary to
bastall or construct (activity)
* property located atc&c�.
This certification is valid thru (date) /0 — a � '- a
s Z-E-- 20/0
Date

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IC Division of Coastal fJl9t. Habitat Impact Computer Sleet
pplican W' Uv► Permit #: q412 595(
Uv,
ate:
/1/10
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)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 final
disturbance.
Excludes any
restoration and/c
temp impact
amount)
s7
Dredge ❑ Fill X Both ❑ Other ❑
3 (P
7V
Dredge ❑ Fill ❑ Both ❑ Other X
O
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 ❑

5770
PILINGS AND MORE 6630/531
/ 457
JOHN CASSIDY
PH: (910) 327-20W
169 LAKE HAVEN DRIVE
SNEADS FERRY, NC 28460
Yo the p
order
der o Dollars l
LL s10
First citiz
Bank 5454P-4
firstcitizens.co
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For 1:0045? 13 2?0 L
1:O 5 3 L00 300