53930D - Sledge

CAMA / DREDGE & FILL " `-
GENERAL 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 77
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7 4 sL t/% 0
QRules attached.
nt Name 4111 0C I h i I t: 4 r+` 1—YY:,7-
Project Location: County j (2:_k,1(v.:;iA)i C.41....-
> , i Street Address/State Road/Lot#(s)
''lL i '1i.. t-'tt',-, - State ZIP iLI ; ) )`7 'e (r\ t-' _ -,
( ) 81-5S5 Fax# ( ) Subdivision
zed Agent City 0 O'l l''fY) ZIP ? (
CW EW ,PTA _DES _-..PTS Phone# ( ) River Basin C Y�n�'n6
OEA HHF 7 IH =UBA ❑N/A Adj.Wtr. Body DN►S C-63\-(A(.i (nat 4
PWS: _i!FC:
yes ;' no PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body v\AN
If Project/Activity pc 0(.._
(Scale: I B:i
ock)length �t�
m(s) 12 xt2' % ( 4► . %) — a- -
i
I
pier(s) I
ength F PRAI
umber I I
v o ad/Riprap length it, t'Ti 1.
vg distance offshore -_ (N. t_ , _
..
iax distance offshore + ,>
:hannel I 4/ '' rAP Ip't�
�.� _`mil f a _ —
ubic yards , i� 1
x la wl
imp �.. ��- _
_ 1 pi„,..„,,,r,v„,.....ez w-ris
fuse/ oatli ' 2. i �1 , 1 _)1 1� i - ._ 1$ ONk.'Ri✓ ..._.
Bulldozing
(
f Li7 ‘0
K‘O
. (!Q
ne Length'- kr.�' 1r(fit or ! I` , _
not sure yes C no ' j ;
•
"gs: not sure yes fio "
>rium: n/a yes ill - ' (v( W dCIC �2L -0-171;
•Attached: yes no L� (
yes fi.c. NI � �� + . ti l 0C 01 1 1
i 1 OR-'L�1�ty1/�✓>>
ling permit may be required by: l'1 '/ t* U See note on back regarding River Basin 1
- . - - -_ _ . - _ .. - --h. In ., . . A., C • .-.-.- . . t-l.l Y i111 _ _..

e ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUIE)
y)
I hereby certify that I own property adjacent to
(Na e of Prope ner)°S ,,/ /4
property located at J/5.66, k)*----' A/Of-4 .6§, i�! - I 6
(Lot,Block,Road,etc.)
onA.,,,,a, � h
, in 1 ,N.C.
(Waterbody) (Town and/or County)Applicant's phone#: Mailing Address: /l5 S& `�/,,
9t6/'
A,t_rif4,141 41C,,w
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)
•
BO c\f L Ff 1IEG
1.2 r /.2 i
-1 - '-.)___ ,
(Information for Property Owner Applying (Riparian Property Owner Info m tion)
for Permit) •
V1:41
//5 5/I
Mailin Addr ss 0 fi r /� Signature

SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVER
■ Complete items 1,2,and 3.Also complete A Slgn-
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, B. Rem '
or on the front if space permits. G- C•
r1
1. Article Addressed to: D. Is delivery address different 11—a
If YES,enter delivery add -
C.e r r( U-c .i fey 6 V
Woo o IAUG24
1( L.0 ��o r kj`('
\ 3. Service Type ",
or
']Certified Mall 0
Registered `fa-Retum Receipt for 11
❑Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) C
2. Article Number
(TransferfomserNcelareq 7008 1830 0001 0339 6834
PS Form 3811,February 2004 Domestic Return Receipt
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