54076D - Lehr

CCAMA/ Li DREDGE & FILL *
IENERAL PERMIT • Previous permit#
few JModification ❑Complete Reissue CPartial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natural Resources ����
oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7,a /2a '
El-Rules attached.
:Name iiQ1 r C.t72 o L. Z.E'Hl Project Location: County Pie u,rf'e:,✓ic,C
lc 0 7ACMr 1449[C/a D,4, Street Address/State Road/Lot#(s) _5,9,7, ""
Lief/ ''C, cN State/VC ZIP,,2 gye4
(9/D) g%Z Lif T-'ax# ( ) Subdivision
ed Agent CA,9,(le,/ /°7AasI- City ZIP
ii CW CIEW I -PTA DES ❑PTS Phone# ( ) River Basin L•Gre/7,
17 OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body 9 I/✓G✓ na)
C❑ PWS: ❑FC: �/
yes / flo`• PNA yes /fig Crit.Hab. yes / no Closest Maj.Wtr. Body G✓
Project/Activity Add /r e[.,/ Rc /+711,,1 /G e1c is),n." l/fiv117/e "?%-,-/A
(Scale:/ 's
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ier(s)(X'S 7,..
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ngth _. .
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P P gt /4 i A
distance offshore I M ~
4
x distance offshore (i" -
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e Length r N c y Il d 'I ✓
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s not sure yes �' i • . _ $ _1. 4 *`" i
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�ium: n/a yes �� �1� � A Ci
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ng permit may be required by: iliQ 1040,4 EPf9C/5 . 0 See note on back regarding River Basin

ALTA
NCDEArt
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H.Gregson Dee FrE
Governor Director Sec
AGENT AUTHORIZATION FORM
)ate: 7 q
4ame of Property Owner Applying for Permit:
a 4-- _.P
Wailing Address:
1/Z 0 )(G? c-P t- WC ,Dr? .
fir ,�, c ., �/z—
Phone Number: ( ) .... : . . .... .... .. ... . .. .... ...
certify that I have authorized (agent) 6 ka;c ks l ' C-e _IL to act on my
)ehalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
;onstruct (activity) 1\leAA) fhQo-'il/l 0- ,
)t (my property located at) / cO 64/7i f t2 `L
(Y This certification is valid thru (date) /e2 l
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01 09:38a Charles Maree 910-842-4049 p.2
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v Jul. 29. 2009 1 :35PMs MaFami ly Foods Inc. 9i0.842-40iNo. 1042 P. 1/1
vtet- • . . .
•
ADJACENT R1PAR1ANPROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PXLINGSBOATLIFTBOATAOt7S'E)
I hereby certify that I own property adjacent to Put (ik Lel 'a
(Nalsi of Property Owner)
property located at 1_y 6 _ U-�C.ri [�P
�+ I (Lot,Block,Road, ere.) {�
an l ,t4 ,in h K,t� . `?eo A ,N.C.
('Waterbody) (Town and/or County)
Applicant's phone#: Mailing Address:
•
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
• V 42 wish to waive that setback requirement,
• D'FSCRYPT1ON ANY)/OR DRAWING OF I'ROPOS'FD DEV .OPMIENT:
(To be filled in by individual proposing development)
4 � t)L I cz- vQci< La i
Prof0sJ.L;T4'
•
LG�
(Information for Property Owner Applying (Riparian Property Owner Information)
for Pencil)
/50 14H /3
MailingAddress P 0,i t.'D.rY1a k Q u)S Si nature
Print or.TypeName
j411€AieoJ4/State/21y p r7 i_

WATERWAY CREATIONS LLC 1316 '
405 STONE CHIMNEY RD SW BS.910-619-0655 66-112/531
SUPPLY,NC 28462-2662 �� O
41
Date
P Ym•deto r othe V V '`I $ zoo. ov
6404-611, 044, Ago�j
Dollars
Cai 5L 1b (Br.)
BB sir BRANC'BANZZAZTRBUBV.C.OmMPANY
For LL01r 3 Lkrittki
1:053 0LL2Li:000529429375411•OL3LE,
COLONIAL CLASSIC•