49252D - Harriman

I'GAMA/ ❑DREDGE & FILL
;ENERAL PERMIT Previous permit#
INew ❑Modification ❑Complete Reissue 'Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources I'
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC rj' ie%' mules attached.
t Name ' Li 4 y /1/9 K AT I r`9/f r''' Project Location: County 7 2 N.JS i c
1 0 f19/of„f�'ap„) „57, Street Address/State Road/Lot#(s) c/l/) I—
Q9•�' .1'G e(U.49( Ai State ``/C ZIP i rY4',
(-Z(•` ) -115 2/ Fax# ( ) Subdivision
:ed Agent 1 7- City ZIP
❑CW ❑EW PTA 8-ES ❑PTS Phone# ( ) River Basin Li.!",
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (1 ,..,,A I l/ /2//4/G-. (nat//
❑ PWS: ❑FC: �/ �� d
Closest Maj.Wtr. Body
yes / no PNA yes J no Crit.Hab. yes / no �g
f Project/Activity , P I /9 C.. e C7� '5 7i�y Y ' 0 P /... c
(Scale:/
>ck)length r5 �x 7 vc.7#0nd7_j�__3( 7 �:
n(s)
I I � l
zngth T -
i
umber I I I
ad/Riprap length ) l
ig distance offshore j } ' ( j
lax distance offshore + T_ !
=hannel � ' 1
I
ubic yards
im , I- _ -
p
wse/Boatlift ,
{
!�LO91 �( 1I 1
Bulldozing , i 1
_,__ r
ine Length
not sure yes no I _
ags: not sure yes c no — f _
orium: n/a yes C no I I ,. -
s: yes ono �7 --,
r Attached: yes r no .- iG P�NS6/�✓
ding permit may be required by:0-P/7,.d 7eSL P em, A 1 I See note on back regarding River Basin

RUBY W HARRIMAN 511
20 ANSON ST 66-112/531
OCEAN ISLE BEACH,NC 28469
011140C
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to de otrko,of CO.C E/4 0. I $ .A0 0. o o
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BRANCH BANKING AND TRUST COMPANY
alawaa/w�il��aa 1-800-BANK BST
BBT.com
I:053LOLL21I:0005LOL69626Ln'00 LL

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property:
(Lot or Street #, treet or Road)
aia ,j
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The indivi
applying_ for this permit has described tome as shown on the attached drawing the development
are proposing. A description or drawing_, with dimensions, should be provided with this lett(
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington,.NC 28405 or call 910-796-
within 10 days of receipt of this notice. No response is considered the same as no objecti
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. (1
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.
Name Date
_�n �^/ / , ,, A •11r1 -

SENDER: COMPLET cECTION COMPI FT'FTHIS SECTION ON DELIVERY
■ Complete Items 1,f complete A. Signature
item 4 if Restricted L ad, - 1
• Print your name and ;reverse ❑Addressee
so that we can return u,
B. Ived by(Printed Name) C. Date of Delivery
II Attach this card to the f the „ailpiece,
or on the front if space -rmits. ��� �� hi 0 UScN
1. Article Addressed to: D. Is delivery address different from Item 1? ❑Yes
(� ,� If YES,enter delivery address below: ❑No
1) 11'?. p re7)c. L G7"c `�
rt
tfli c� 1C )-!e/ 3. Service Type
/ l/• 0 Certified Mail ❑Express Mail
❑Registered 0 Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7008 0500 0000 3878 7399
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
•
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- ( 2° 74lA5C