54050D - Shirley

CAMA / ❑DREDGE & FILL - `'
IENERAL PERMIT Previous permit#
lew ❑Modification ❑Complete Reissue ❑Partial 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 15A NCAC ) `\ \ Z,3 1/4-
rules attached.
t Name 12•-00 1 E %-\ LQ.LL: Project Location: County 7 r ,J i� )L
1 .Z i D L i> 4 0 i(G ►i T cL.2t Street Address/State Road/Lot#(s)
IJ iHT G u at-r State{v L ZIP Z7SLl s "Z...: J L I TT L E Z 1J.S-►op...) 12-
(q10) R-7c - 594 L Fax#( ) Subdivision
ed Agent c)1.t,2 0 to S f ►J\adt E City 3 .f GiTV ZIP 2..g441.
❑CW CAW L)PTA E ES ❑PTS Phone# ( ) River Basin �A,6
❑OEA ❑HHF ❑IH ❑UBA ❑N/A �' ,P.>
Adj.Wtr. Body ) .?SlAl•L
❑ PWS: ❑FC:
yes / PNA es no Crit.Hab. yes / no Closest Maj.Wtr. Body
'Project/Activity I,..).,'S pa L t- (o `C 5 PIE R i o J 1 S A. 9 L - i 1 c A.N. ) . x L`'
I L C.K-1-w r t A( AIN) ) Z.-x I Z i?-• -a;LI F\ (Scale: )i'r.
ck)length (, V 46
Iflii.lb i '_. MMI
ier(s) 44=
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mber IM� �7�� =■��
i
d/Riprap length er■ ��.
distance offshore y w� ,_�!II
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ix distance offshore lilli�aM� ■!
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bic yards • INN I I
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not sure yes no I -11� 11 !
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urn n/a yes no
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Attached: yes o 1 - �-N_—UM
mg permit may be required by: -'NILA 2c CI`I `/ . ❑See note on back regarding River Basin I

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property ownei
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a mark
contractor or other individuals acting as art authorized agent on behalf of the applicant.
This form was sent to you by the following individual or company designated by the applicant as an
authorized agent:
ifo
Audio d Agent's Signature Date
Name of Individual Applying For Permit: /— _7`
Address of Property: D 2.t
(Lot or Street r, Street or Road)
ci/f
(City and Cou )
I hereby certify that I own property adjacent to the above-referenced property. The individual applying for this pert
has described to me as shown on the attached drawing the development they are proposing.. A description or drawir
with dimensions. should be provided with this letter.
_E_` r I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Management, 1
Cardinal Drive Extension, Wilmington,NC 28405 or call 910-796-7215 within 10 days of receipt of this noti
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back
minimum distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive t
setback,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
._� - • A

CERTIFIED MAIL -RETURN RECEIPT REOUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owner
indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marin
contractor or other individuals acting as an authorized agent on behalf of the applicant.
This form was sent to you by the following individual or company designated by the applicant as an
authorized agent:
rei'vAJ/syASignature Date
Name of Individual Applying For Permit: /Zvi" t � `4 zi
Address of Property: c2.10 ///l.,t �ir'� ,-
(Lot or Street#, Street or Road)
(City and County)
1 hereby certify that I own property adjacent to the above-referenced property. The individual applying for this perrr
has described to me as shown on the attached drawing.the development they are proposing,. A description or drawin
with dimensions. should be provided with this letter.
( P I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Management, 1J
Cardinal Drive Extension, Wilmington,NC 28405 or call 910-796-7215 within 10 days of receipt of this notic
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back
minimum distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive ti
setback,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I/ T J_ _�•...._L ... ........,. �L... 1 ..�.L....i. ..e.....-n.,-.enr A A

PILINGS AND MORE
JOHN CASSIDY
•
PH: [phone] 5497 f-)
169 LAKE HAVEN DRIVE
SNEADS FERRY, NC 28460 �v� 66-30/531
457
P Yto the uA1e
order o
$ o7'tY, ov
/fu k, mv:
y."
e�ex.
First Citizens
Bank
firstcitizens.corn
For (-�P5I0
1:0 5 3 100 3001:0045713 270 L 5497
COLONW OIASSICA