54405D - Arsenault

CAMA / �DREDGE & FILL
iENERAL PERMIT
Previous permit#
lNew ❑Modification ❑Complete Reissue
El Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources
�v
:oastal Resources Commission in an area of environmental
concern pursuant to I SA NCAC
[?Rules attached.
t Name
Project Location: County' `>>,-
Street Address/ State Road/ Lot #(s)
State ZIP
SiArr• NS
( ) Fax # ( ) _
Subdivision
ed Agent
City ZIP
-i CW ❑ EW a PTA `j ES U PTS
Phone # ;kZA - LI LO Z River Basin . r�
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A-
Adj. Wtr. Body .5ror-\ ? S- .a -!> (nat
❑ PWS: ❑ FC:
yes / no,,..., - PNA yes,T',no Crit.Hab.
-
yes / no Closest Maj. Wtr. Body 1 W ✓��
Project/ Activity f- E'
(Scale: %le
:k)length
igth
nber
i/ Riprap
distance
x distan(
iannel
)ic yards
ip
se/ Boat
Adozing
a Length
not sure yes n
5: not sure yes no
yes n,
a
Emil
ng permit may be required by: lr 1 F GZ T L
❑ See note on back regarding River Basin

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to tL c _ f1� ��y Lr
(dame of Property Owner)
property located at
t"
(Lot Block, Road, etc.)
on �UaTe�'t � i�-�-1 , in c� N.C.
(Waterbody) (Tow and/or County) _
Applicant's phone #: `2 10 -3 ZAP 4-2-o 3 Mailing Address: Q J*P tJTerNSav I
S vte-Q C1 t:rj, 1 .c1r_ z.
He/She has described to me as shown below the development he/she is proposing at that cation,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
FT
Li
J Q
it you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in wri
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Eat. Wilmington, N
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
(Property Own Inf ation)
Signature
Print or Type Name
(Riparian Property Owner Inffoorrmation)
Signature
Print or Type Name
Mailing Address
Mailing Address

-dam/, V C-"J
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to r a S Aps GAm �,S(
, (Name of Property Owner)
property located at c;2- a- ?I
Sa NA i<d
(Lot, Block, Road, etc.)
on "d EE5 ��`'� , in S u i2 j�) e t N , N.C.
(Waterbody) (Town and/or County)
:applicant's phone #:9 (<) 32-,-P 4 Z 03 Mailing Address: ASS t47-r(NS" '( t
cj,e e A) c
J' 4-4 s
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
ru f 14-02� L
(Information for Property Owner Applying
for Permit)
Z. 8,' XT4 (At So v T- F—J
Mailing Address
2- %
I
UX9 -a l4vA?4
(Riparian Property Owner Information)

A
NCDENR
North Carolina Department of Environment and Natural
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
3overnor Director
AGENT AUTHORIZATION FORM
ate: I 1 9 1 d 5
ame of Property Owner Applying for Permit:
�) E, )'Ls -�;-cA "-ve 5 t)4eS C V.4 v L 1
ailing Address:
P,p 17. T P-cl
S U lei e t' . 42 e. 2 vP
lone Number: (` to 1 3 Z g- 4 Z© 3
'I10 Zoo 4-� 18
Z)elLrll- 6ocr r&)VV ,I r-",N—
Resources
Dee Free
Secr(
;ertify that I have authorized (agent) (;mm=2--, ?-o to act on my
;half, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
instruct (activity) (29- P IAOle rke�T 3u l k- 4a q D ,
(my property located at) 2 f58 ATf,-tUso,u -PT d v C.tnl , A) L
7-S
his certification is valid thru (date)

DELTA DOCK & BOAT LIFT
402 AQUARIUS DR. 910-686-9700
WILMINGTON, NC 28405
IITO THE PAY
ORDER OF%/ C�I�/� t_
L-m
DATE �I 66-30/531
365
®First Citizens
Bank
�( firstcitlzens.co�m�`�
FOR
AP
1190080119118 ':0 5 3 100 300400 3 5 3 19 9 1 5 41I- `