54083D - Henderson

CAMA / DREDGE & FILL ":
E N E RAL PERMIT Previous permit#
New __Modification _ Complete Reissue' ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources �
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ) ` i . I Zs`L)
Rules attached.
nt Name -ASt Of N rt .) Project Location: County O OS 1_,.. ..,.._.)
s )Og W."0 ESf c.J 6 P L Street Address/State Road/Lot#(s)
4.:,Y4Jr..X/Z4.-c.6 State is) ., ZIP 4o i Li�— P, L.t 0 -2.." j'£- 12-d
#(Qc,) LK • O50(O Fax#( ) Subdivision
'zed Agent CityS0 E 17 S C t a k\I ziPam$t4
d ❑CW ) $W TA ❑ES E PTS Phone# ( ) River Basin VI pit-
:
El OEA ❑HHF ❑IH ❑UBA C N/A
I: Adj.Wtr. Body0,HAn..Jsc.t_ &A Lc AL'/nat
PWS: ❑FC: IJ vv lz. v&
yes ,f-o, PNA yes Crit.Hab. yes / no Closest Maj.Wtr. Body
of Project/Activity Z At.� ?1 L-1, Z.✓ E.x J T Z - .- . L ?
(Scale: I��-
dock)length
rm(s)
•pier(s) j-
length i - 1
if
lumber
sad/Riprap length
ivg distance offshore I N k) L...I
nax distance offshore
channel i
I
:ubic yards I
amp
ou .. .Boatlift ) I ! f
Bulldozing : I .I j
N , LT�'T
i
ine Length ISO * �`' I
I ��'not sure yes n0 F jii
I l
3
sgs: not sure yes Z
orium: n/a yes - —
1
s: yes 1 I i
r Attached: % no 1 1
ding permit may be required by: 003 1, 3 vJ H N \..{ •
n See note on backregarding River Basin

09 08 04: 55p p. 1
•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to ,SaS ,. `-I
(Naihe of Property Owner)
property located at 1`c Z VS 441 i h v �
T • '
/ (Lot, 1)0
ck,Road,etc.)
C w:c.4 —Co-r,w./ , in ew1� 1:-"Ir ,N.C.
(Wat body) (Town and/ r County)
Applicant's phone#: O ' IS t5 Mailing a Address: D SI' LJ e cct /
: .45-oj a 14- '.c. J-g5-9
/
He has described to me,as shown below,the development he is proposing at that location,and, I
have no objections to his proposal.I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet(15') from my area of riparian access unless
waived by me. (If you wish to waive the setback,you must initial the appropriate blank.
below.)
I do not wish to waive
�II do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
,, eidai) /4646',;--.—
.--z •6
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
' 1113
D �J�ut�5-�- til€ - (.
Mailing Address Signature
, 4c-ksvvw ( (< `-e1.c. 01s�� L V �( 1-i e r(
City/State/Zip I Print or Tie Name

09 09 04: 55p p, 1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to .�bS€ k 1-1-e-pdays„,20.-
(Naihe of Property Owner)
property located at I 4- _ 6€,6( et2 ILL.
(Lot,Block,Road,etc.)
, in Sr /
s 1'� ,N.C.
(Wate ody) (Town ail/or County)
Applicant's phone#:/f0 70 05-6A Mailing Address: I(0 U;-kie-Sf EW el.
-1A41, 2csLR
He has described to me, as shown below,the development he is proposing at that location,and, I
have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet(15')from my area of riparian access unless
waived by me. (If you wish to waive the setback,you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
�Ocv� 1-10 ck-wo
A
140
t-t-
(Information for Property Owner Applying (Riparian Property Owner Information)
for Perinjt),
1---•• .
Dili�g Address 2 gsc�6 tA.d‘r‘--1/4-e-jt Signature
Se.c,KS o I,- 1-e_
City/State/Zip q 0_4sei _ 0S6 6 Print or Type Name

JOSEPH J HENDERSON II l
PUH.(sAa)4H HENDERSON
10gWINESTONEa 28546-5270
JACKSONVILLE, ��O'
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Q T BRANCH BANKING AND TRUS-.cox-,ANY �-B
B1I&T �Epp-BANK BBT BBT
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1:053LOL12LI:000510288 ? 26
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