50209D - English

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❑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 j/, /20 O
[ Rites attached.
nt Name /9 ''i e frzio,lie C A';L, s S Project Location: County R a y..., S w,C/(
s S ;3 Re,,,, 4,i .5c-1• .51'✓ Street Address/State Road/Lot#(s) J'9 i4-2L"_
(d et / State/VC ZIP-2- 7 Y 2
9'o) jr7'y.I-i'26,5~Fax# ( ) Subdivision
zed Agent --SC s /7' ,U 't ,i .5' City ZIP Jl
❑CW [JEW D-PTA 'ES ❑PTS Phone# ( ) River Basin L4/n/
❑OEA ❑HHF ❑IH E UBA ❑N/A
Adj.Wtr. Body / 1-.'1/!^'n ( .
El PWS: FC: I�// it./ ‘,./yes ,r•�c? PNA y no Crit.Hab. yes / no Closest Maj.Wtr. Body
a Project/Activity 6e , VA 11 f b: P it /7) & C/cr
/ � �' (Scale:/
ock)length /2 jt
pier(s) I 1
ength i I(p
umber
ad/Riprap length I J b
ig distance offshore
lax distance offshore i
:hannel j
- I
ibic yards j I
imp I /2 ' I
use/Boatlift f '
Bulldozing
A I
ne Length / 5- ' I ! k✓ / f' y!uk l 4l
not sure yes t�'S' t d , 0 .4 ! I i I Id
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gs: not sure yes 1 4 4 y ^ • t
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mum: n/a yes I
yes clii
Attached: yes `
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ling permit may be required by: 3,7 N'.S a/,CA? (0 yr r^r I I See note on back regarding River Basin
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A B & K MARINE CONSTRUCTION I
4 P.O. BOX 1417 PH. 910-231-5438
'j WRIGHTSVILLE BEACH, NC 28480
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DATE I)!. O
ti PAY D��/
TO THE I
ORDER OF
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/.t.�ST ACCHytRT 061000104 n y//� l/
FOR C. // /�1 / / �K.h/V/� -' _.w"
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DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN
PROPERTY OWNER NOTIFICATION/ WAIVER FORM
Name of Individual Applying For Permit:_! qaiie
f R A►J I i 5 k,
Address of Property: c) of 3 9 6 w Pi 54% w
(Lot or Street #, Street or Road)
Su (� I I� . C 09ail ��u� sw lc
(City1aand 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 Lett r.
I have no obj ctions to this pro I.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or can 910-796-
7215 within ten 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 pier, dock, mooring pilings, breakwater, boat house, or boat lifts
must be set back a minimum distance of 15' from my riparian access— unless
waived by me. (If you wish to waive the set back,you must initial the appropriate
blank below.)
I dq,wish to waive the 15' set back requirement.
I do not to waive the 15' set back requirement.
Si Name G21-7.19 Date

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