54078D - Bostrom

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
NNew - Modification ❑Complete Reissue' ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC I Z
_ l les attached.
nt Name �! f, dL pjC TRPa►1n O i 1 t' t4 , �j z(i Project Location: County !� I tG 0�iC I
is 1' PP te-c- iE Street Address/ State Road/ Lot #(s)
_ ELM N&TOt-J NC, State ZIP 2k
# ( ) 231—`651 `4 Fax # ( ) Subdivision
-ized Agent T?VytM 4 N OLT`A City "%� it ZIP 2 g Y
d cw , fw —,-*PTA ❑ ES _l PTS Phone # ( ) River Basin 66
C OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
1: Adj. Wtr. Body lam?' ff—,A'DCC c-/ G�-E"t✓�7t-f�
❑ PWS: ❑ FC:
yes no PNA yes 7 no Crit.Hab. yes / Closest Maj. Wtr. Body
of Project/ Activity
( LAif "r,4fy
lock) length /
rm(s)
pier(s)
length
camber
ead/ Riprap length
svg distance offshore
nax distance offshore
channel
:ubic yards
amp
ouse/ Boatlift
Bulldozing
ine Length
1
not sure yes
ags: not sure yes no
ovum: n/a yes
s: yes
r Attached: yes no
tJgfrOv— l S' AC1 t
7� To t"/(s1
(Scale: it
ding permit may be required by: W. ❑ See note on back regarding River Basin
/ J

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64
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2L�'L.510N Oil COASTAL �`A0H
ADJ,6.CENT RIPARIAN PROPERTY U�U:i'�R NOTIFICATIO ,,'Y AIVER FORM
Name of Individual Applying For Permit: C,
Address of Property; ;q O -2- 0C, C, /,-
(Lot or Street 4, Street or Road)
-- - �-J,k 6, " , , To#
(City and County)
I hereby cettify that I own p-operty adjacent to the above -referenced property. The indivi(
applying for this permit has described tome as shown on the attached drawing the' development'
are proposir g. A description or drawing, Nvith dimensions, should be provided with this letter
�2
I have no objections to this proposa.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7
within 10 drays 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 beat lift must be
bek 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.)
I do wish to waive the 1 setback requirement.
I do not wish to waive the 13' setback req
uirement.
Sign Name Date

2 Y1SiV1V_OF COASTAL ;� _-A1NA6Hi'1F_ '1_
ADJA,CENT RIPtl,RJAN PROPERTY M\NERN OTIFICATIOi1;'WAIVER FORM
Name of Individual Applying For Permit: Qc. L ( nrc) ,
Address of Property; c) ;1_ flo o
(Lot or Street 4, Street or Road)
6 J"/. . c
(cit), and County)
;) T 6_/o <
I hereby certify that I own property adjacent to the above -referenced property. T.he indivic
applying for this permit has described to me as shown o : the attached drawing the development 1
are proposir a. A description cr drawine, with dimensions, s'iould 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 Coa
Management, 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 mininium 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.)
Sign Name
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 15 ' setback requirement.
. �/ s &/,q
Date
-WA

FROM s JfmmV North — CMC
FAX NO. : 9102566357 Ju 1 . 16 2W9 M 46M P:
t NCD,EcNR , a..r tval,,'a'
olvil;lon of Coacta! �IansQement
C-W(QS 5, 1a'Actat
Authorized Agent consent Agreement
xiam G. Ross 1• , SN'"Y
� C_,,,�,.`�, 45 hamby autharxed to act on my behslt
order to eisrein any CA -MA pe'rnitiSl-egUirad far the prDpORY' e:ad he�ow Yr,e ®uC^o�l! abort is im ted tc : •
:ecl'ic activities daschba,� in the ahachad skelIVI
t OCATION OF FRQJI'GT:
n/C •QS44,.�,
'ROPERTY OWNER MAIUNG ADDRESS,
NUTHOR;ZED AGENT MAILING ADDREBS:
PHO14r. so(q tq)
i - , 1; .
PHONL NO. t7
signature of ptoptrty Owner, "' »-----2---
Sigrawre of A:rthorttd AQAnt:
D atf: —�---

\STAL MARINEpDOCKS & BULKHEADS
NC3831595
6314 WWI M6-6357
INGTON, NC 28403
E�
i •
l4
WACHOVIA
Wachovia Bank. N.A.
wachovla.com
non L657 21t" 1:053000 2 19i: 2086
16572
66-21/530
BRANCH 50004
DATE O
I $ ado
�- DOLLARS 8
L 70 2 89 — — -