50361D - Branch

LCAMA/ ❑ IT°DREDGE & FILL •
NERAL PERMIT Previous permit#
id New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources r; ,i /�
• Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC / //, /? 00
❑Rules attached.
nt Name dv j Z 12 `z I� / , {' Project Location: County .811/4 St,i/C.4.—
.s7"..1-/?- .CI r171h 1/? Street Address/State Road/Lot#(s)
`..,/u fie-- State ZIP /X L 4,wln b1,,, St .
#(90`f) ,5 vv-,)tf; Fax# ( ) Subdivision
ized Agent City i(C LS IC. &F ZIP 7 k
d ❑CW i2frEW LIPTA 0.ES PTS Phone#
( ) River Basin !/i
❑OEA ❑HHF ❑IH 0 UBA ❑N/A
): ❑PWS: ❑FC: Adj.Wtr. Bod a °IF Al Ail (nai
yes / no PNA yes / Crit.Hab. yes / no
no kit 4/Closest Maj.Wtr. Body /71
of Project/Activity / 2/i Y,c /C fie,-/- 7D c f/,mod do C-t_
(Scale: I.
(dock)length-2 Si iY(o 'y l fo V A- ' t(
1s
)rm(s) f
it pier(s) 1
length
number �- ` - IN-F
lead/Riprap length i I
avg distance offshore t___ i
max distance offshore
,channel
cubic yards 1 ;
H
ramp / I(0/ .....
louse/Boatlift
� i
1--.
1 Bulldozing
PV/Oet'4 /(o 1 V r6 '
1 . ask--I---
` I I
line Length . i
not sure yes no j � - 4
lags: not sure yes no -} -I-- r---
:orium: n/a yes �
no I' v {__.. T 1 I
s: yes no'
t� mli�► 4 LL ' �j I j '
t
:rAttached: yes no I r7V 'I
(ding permit may be required by: On'�-- /S/G 6(a cam- ❑See note on back regarding River Basin
sLSoecial Conditienc 7-hi,i/Iirl tiA .ic I- MI)7 4 u !., rl 2A,.n. .1 4 v , c 4 ,

WILBUR RAY BRANCH 1238
NORMA C.BRANCH NCDL 7883780 —
4217 Stourton Ln Ph 704-544-2417
Charlotte,NC 28226 / ,,p - BRANCH 66-21/530
1�/d-i �a,,.JO 77543
DATE
I PAY TO THE t� t �
3 ORDER OF N C..•.D `, N 1 I 0D
u - •41-wo \- DOLLARS 8 iF.^.
III WACHOVIA (27 c a.) W C-%-
Wachovia Bank,N.A.
wachovia.com 6p ti r3v(-U
FOR L.Aa&-, l� N"
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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 owners
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 marine
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:
Wes .
Authorized Agent's Si.. tire Date
Name of Individual Applying For Permit: (.,L k •xv. LAI
Address of Property: k'2z, LAva., o S .
(Lot or Street#, Street o' Road)
Cl Ca.,ot1 1 e ,35..A\c.4-. 1
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individual applying for this permit
has described to me as shown on the attached drawing the development they 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 Coastal Management, 12'
Cardinal Drive Extension,Wilmington,NC 28405 or call 910-796-7215 within 10 days of receipt of this notice
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 th
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. AwA