52582D - Golder

. CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
New 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 5A NCAC J i, I Z. O.
Rules attached.
t Name llF f"{t��y t,0�e. Project Location: County ?a -b a ,
'is 13 j 3 t.J 1v 1:I.✓ v t . ; ) rL. Street Address/State Road/Lot#(s)
"QC-- Grc1 State 0C. ZIP2? LjS' 1"2-)1'> 1.‘i• lJi-' D.-ZNriL.- ••..NL
#( ) Fax#( ) Subdivision
•ized Agent t- i L.i.-Z t_-') CitySv.ct..( 6.'S.�1 ZIP 2 9
d ❑CW fW TA ES J PTS Phone# ( ) River Basin C... a DC
0 OEA ❑HHF [ IH 17,UBA ❑N/A ,—ST�" C c c
I PWS: JFC: Adj.Wtr. Body` } r'rt �:��� n.
yes / now' PNA yes no Crit.Hab. yes / no Closest Maj.Wtr. Body S i�`1-v-. Q S`'0 is-2�—
of Project/Activity S AL` L4 / ?I-A /.. / g X j 3 ?1z-A-(1Z Q.—r‘....
j i i� ��? � (Scale: II':
lock)length )(e el c 1 _
rm(s) v X le) 1-� l
' I i , � �
i v5.-- "'"•-..................L........
•pier(s) i
— C 1 jG��JU"
length 1 I
lumber I �f $ ��- ��
i
sad/Riprap length ! j O
ivg distance offshore _
nax distance offshore
channel I { +
j
:ubic yards
{
amp
`ouse/Boatlift
1
um
Bulldozing
1 CT it i‘ .J•J + _ j
.
ez-,....,, 12,4-agew 1 , 1 1._ liliik k 4. ,---
ine Length :
not sure yes no '- 1 - �T1
vs: not sure yes no- j I
orium: n/a yes no 4
PI
>. yes no i /if
r Attached: yes no i l 1 I
ding permit may be required by: \\Jc ci- (.---17\/ U See note on back regarding River Basin
.i c-- -1..---._._--- )Ate a pl.: :y.. . c t_. T► . _ ) 'h o ' ' ,. -- --

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Label/Receipt Number:7009 0080 0001 7201 2258
Class: First-Class Mail® Track&Confirm
Service(s):Certified Mail' Enter LabeVReceipt Number.
Status: Delivered
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Your item was delivered at 1:09 PM on June 4, 2009 in GRIFTON, NC
28530.
Detailed Results:
• Delivered,June 04,2009, 1:09 pm,GRIFTON,NC 28530
• Notice Left,June 04,2009,8:21 am,GRIFTON,NC 28530
• Arrival at Unit,June 04,2009,8:10 am,GRIFTON,NC 28530
• Acceptance,June 03,2009,2:37 pm,HOLLY RIDGE,NC 28445
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Label/Receipt Number:7009 0080 0001 7201 2241
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Service(s):Certified Mar Er ar LabeitRaneiptNunter.
Status•Delivered
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Your item was delivered at 1:02 PM on June 4,2009 in RAtEtGH, NC
27606.
Detailed Results:
• Delivered,June 04,2009,1:02 pm,RALEIGH,NC 27606
•Acceptance,June 03,2009,2:37 pm,HOLLY RIDGE,NC 28445
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO UF'ICATION/WAIVER FORM
Name of Individual Applying_For Permit: I1(0 / )O I d&r
Address of Property: )3) A , 11,6a j Je( ,(�f�
(Lot or Street#, Street or Road)
_ ()) er)7jt a�s14 �
Optinj)
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The i ndivic
applying for this permit has described to me as shown on the attached drawing the development t
are proposing. A description or drawing, with dimensions, should 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 910-77%
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
[ understand that a pier, dock, mooring pilings, breakwater, boathouse or boat lift must
set bck a minimum distance of 15'from my area of riparian access-unless waived by me.
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
,,1 i
C
>IgaName. Date
/d A .` n -.. 1 . •-r-- AWICIFA

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U.S. Postal Service,.,
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