53996D - Congelton

I CAMA / DIDREDGE & FILL E °
.ENERAL PERMIT Previous permit #
-New -`Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources j
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC rl (ule
,�+ A Rules attached.
it Name 1 Ut 1��1 AS b illy 4L iy
l��a 1t1(d �h old
I It i.l n State LI ZIP ?ill
(� u Fax # ( )
zed Agent 1 a✓ G S� I k( ASK,
❑ CW ❑ EW ❑ PTA �ES X PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes)/ no PNA yes no Crit.Hab. yes / no
if Project/ Activity
ack) length
n(s)
pier(s)
ength
ember �+
ad/ Riprap•I 'gth a`
og distance offshore_.,
iax distance offshore
:hannel"
ibic yards
.x4,
mp
'use/ Boatlift
Bulldozing
ne Length
' II
.1 1
Project Location: County N F w HG( i'1GU L r
Street Address/ State Road/ Lot #(s)
d�( �A I ��IOI/Y��S VUPA
Subdivision N / F
�itY��i1�VNl11Ct '?1 ZIP
Pho en # (JLD-) 5a0' 5660 River Basin
Adj. Wtr. Body V otill tnath
Closest Maj. Wtr. B dy W
(Scale: NT'

,r-RTIFIED MAIL — RETURN RECEIPT REQUESTED
LI VISION OF COASTAL MANAGEMENT
AI MACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER
FORM
Name of individual applying for the permit: 1644D S G 44 ?v •S%
Address of property: Z �?0a 6y, /�/ WAY S %z
a.« or streets, sb wt of maU
(City a sty)
I bereby certify the I own property adjacent to the above referenced property. The
Individual applying for this permit has described to me (as shown on the attached
drawing) the dew I FE t they are proposing.. A description or drawing, with
dimen ions, dmold be provided whit tbis letter_
+. $--I have no objections to tbis proposal
If you have objections to what is being proposed, please write the Division of Coastal
Mamma,]" Cardinal Drive Esteadon, Wilmington, NC 28405 or call (910)
796-7215 witbin (10) days of receipt of the notice. No response is considered the
same as no objection if you have bem notified by CerMed Mail.
Waiver Section
I nuderstwd that a pier', dock, mooring pillugs, brawater, boathouse, M or
sandbags must be set bw k a M1hdM1M1M distance of 15' From my area of riparian
accew 010hMs 'waived by me. (If you wish to waive the setbwdr, you mast initial the
appropriate blank below.)
!� �I do wish to waive the 15' setback requirement
��+ 1 do not wish to waive the 15- setback regwrements
g Date
Y/L�► �,/c 1,4- f�%o
Print Name
X 9/0 Z3Z - �zoa
1 eleohon _ numb with sar" t-M,-

.l-
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f
Authorized Agent Consent Agreement
E % y gp 5 �'cwcv v �ca�J t 1 ��' � `f1z. is hereby authorized to act on my behalf
... _
{ t?nntect Nnn s of ,:19e.�t}
I in order to obtain any'UAIN,1A pennft(s) required for the property listed below. The atsUhorizatian is (iinit�d to the
r f
spat.;fid a ,tiulties r3Psc ribed in the atta.^.hid sketch.
tN'
I -
LOCATION OF PROJECT:
:.
PROPERTY OWNER MAILING ADDRESS:
„ v7, NIC 28 1. w
rJ �
} IQive NO,
_ _._ .
AUFHORiZE❑ AGENT iVAILiNG ADDRESS:
�f2Aj^
PHONE NO, _. �� �Dtc20
Signature of Property C)wner.
Signature of Authorized Agent:--

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L'tiuo _�v✓, £<w .�.,. aae r.�a _�... _ ,. ..< «�. _
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" - BANK OF AMERICA, NA = 5 J
DMC Contractors, Inc 66-019/530
2728 N 23rd St. — — — -- _---- -
DUNCAN Wilmington, NC 28401-2755=- -���-- -� — �— -- --- - -- ---- '
MARINE [phone] CONTMCTORS. INC12/OZ/�!
------'-"'-"- -- ""---
PAY TO THE DENR
ORDER OF
Two Hundred and
- DOLI
LA
0 5 7 — _-�
090I'm 1:053000196IN
1
:�23700744009611'

■ Complete items 1, 2, and 3. Also complete
Item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece
or on the front if space permits.
1. Article Addressed to:
�(r5. Sohn"D.-4'n,°1`�
(� Vanish Oobb Cr.
3C\- tnna-��a
A. Signature
'1 ❑ Agent
Addressee
ved WjPrinted Name) C. D e of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No .
RECEIVED
DCM WILMINGTON, NC
3. ServiceTypeU!1L
0 3 [uuj
❑ Certified Mail
Q Express Mail
❑ Registered
10 Return Receipt for Merchandise
❑ Insured Mail
❑ C.O.D.
4. Restricted Delivery?
(Extra Fee) ❑ Yes
2. Article Number 7006 0100 0004 4046 5751
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540