50229D - Crossmore

❑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 ,[�
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 2/'' /2 G U
,`�� , , ' a`1 / es, 1 attached.
nt NameL/Zo,S.1 .'e7( e -Cc .4i cur/'> 1/(-'c e,FO Project Location: County 3,y,✓S c✓ c le
2 u c Street Address/State Road/Lot#(s) /5 ,Po"/2;se
i aS$/►?art t State/'/ ZIP) i"4,/ ,
#(a) 7,73-y' (>5 Fax#( ) Subdivision
zed Agent ,1v o_ I lC I"4_ 5 City PP.., -if 4. OP-4c ZIP 2-F '
❑Cw ❑Ew ❑PTA ❑ES ❑PTS Phone# ( ) River Basin --.+,/__
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
��/�/"„/
Adj.Wtr. Body (f2,✓/, i r , (nat
❑ PWS: ❑FC: /9` A111//
yes / no - PNA yes Crit.Hab. yes / no Closest Maj.Wtr. Body
rf Project/Activity R P fLgc e Cx rs f,,,/, (!fil 'd! /.e / i e�'
(Scale:/
ock)length 5v,e y i ,e,e)7 lb X v
•
r(s) i
I
pier(s)
I
ength - . ! I
imber
ad/Riprap length C g _ !....‘r--- ,
rg distance offshore !
lax distance offshore { i
:hannel
ibic yards C i
mp y.
use/Boatlift !
— ( F' ' I
Alt 1a
3ulldozing
D
1Ga� / � e I
� ,xib
ij
ie Length )£/ r !
not sure yes Clio- Ai i. r i I ` *— ir----_
gs: not sure yes sa) t,0 i
' � I
{
rium: n/a yes 0I
V I G
yes J L� 0' I
t
Attached: yes J �, �
`
ing permit may be required by: OCP 09 ' -1S1-e 'P69G A 1 I See note on back regarding River Basin i
t'Tn.,�.,-.. A . r .y A I -1 f" . '1 ;l . ,,1

THE SACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATER MARK-HOLD AT AN ANGLE TO VIEW
WESTERN' 'MONEY INTEGRATED PAYMENT SYSTEMS,INC.-ISSU
U N I O N ORDER Greenwood Village,Colon
08-873503171
82-40/1021
PAY EXACTLY �
PAY TO THE 4�� `�//� /�(' ; ; I C- iA <
ORDER OF / Q
A.Jhatte -7F—)3207e‘/7,
UNE AR TERFE DRAWER
an SIGNING
SOUHA AGREE
LG NE TOME TEOR THE IIEVER!
Western Union Money Order end Design is a service mark of Western Union Holdings.Inc/Payable al Wells Fargo B k rand Junction-Downtown,N A..Grand Junction.Colorado
1: LO 2 LOU 4001: 40088 ? 3 50 3 L ? 1 Lit' GQ 60 242-1

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FAX M0. : Jul. 14 2002 03:25PM P2
4-21 O7:tfi B!COISMICTIOR 91 -846-330»8287333250 P2/2
Nz:rth Ca,oi a Department ct et:4,11eri and Watura Resters
Go vs,'
of Management
r.r;n G C%YS-FY s,' H.Groton.Director fien;ia{ M7fibJ �1C�OL
Authorized Agent Consent Agreement
11711 /i 'r.i ��r��Jl v �`�z is Pereby autr.iced to acx On my be►haff
rrtrea Nm Agowl
Of it:to obtain any CAMA permrt;`s'}wired for tne prcaer4 +:steel beiow Me a;lthCrzat+on is iirnmeto tp the
Decifrc a +vitres d'secrbed in the at±ac.`ted s+cetch
OCATION OF PROJECT;
ROPERTY OWNER MAILING ADDRESS:
L'°CK 2.cf3
C_fos„s'N o/W /t1< C( 2 e6
PHONE NO $2 73-3 -1(30.s
.�TwoaD AGENTotJv(., Rooks
J f MAXUNG ADDRESS: Q 7 (,(
LC pi 5.S/ (1 t-w_. lre,t/ _ i.,32
.� .... ..�.__.._ PHONE NO(�. 9f ' P i-.(• `ic7r
;nature of property Owner /
;ratu:e of Acthorue0 Agent c / r;7 (c*)4..J-l

(- c.Io- g . 3(06
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying, For Permit: r re) 5,5incl'e S Act)/
Address of Property: /S ,t-Nd r r s /
(Lot or Street#, Street or Road)
Oc_ (c'-V . S/E'
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The indi
applying for this permit has described to me as shown on the attached drawing the developmei
are proposing. A description or drawing, with dimensions, should be provided with this let
ir I have no objections to this proposal.
P P
If you have objections to what is being proposed, please write the Division of C
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-39_5.
within 10 days of receipt of this notice. No response is considered the same as no objec
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift must
bck a minimum distance of 15'from my area of riparian access-unless waived by me. (
wish to waive the 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.
7707-/..00,0 4-r7 2 -a 9
Sign Name Date Arw. A

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. / // ❑Agent
■ Print your name and address on the reverse X /_..(4=///�, ❑Addressee
so that we can return the card to you. B. Received by('ranted Name) C. Date of Delivery
• Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: 0 No
jCL/Yh geGCe-f/'ec— Bp ON/
_'IOD ,z1 1 tit J ,
0 n _Y4 t d f\C 3. Service Type
�J�P 1C ) 0 Certified Mail 0 Express Mail
O Registered 0 Retum Receipt for Merchandise
O Insured Mall 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number
(Transfer from service label) 7005 0390 0003 5187 3425
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-154o
SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
U Re,7lOr11
item 4 if Restricted Delivery is desired. ❑Addressee_
• Print your name and address on the reverse
so that we can return the card to you. Re ed by(Printed Name) C. gate of Delivery
• Attach this card to the back of the mailpiece, y//? dg
or on the front if space permits. /� 0 Yids
D. Is delivery address different from item 1?
1. Article Addressed to: "� If YES,enter delivery address below: 0 No
nc3. Service Type
J F,1 1 j 0 Certified Mail 0 Express Mail
❑ Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7005 0390 0003 5187 3432
(Transfer from service label)
PS Form 3811, February 2004
Domestic Return Receipt 102595-02-M-1540