50286D - Russ

❑CAMA/ ❑DREDGE & FILL
GFN ERAL PERMIT Previous permit#
❑l Jew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
iorized by the State of North Carolina, Department of Environment and Natural Resources �/a i2 o G
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
ElEiles attached.
tnt Name p y,S ?`/ le t S 5 Project Location: County,Tjl i'„.5','1C/C/
�
os /,2 ' R , / '',z CAS (/ -7 b 1.a, Street Address/State Road/Lot#(s) 5;049 7)-7 f
` '' State/Y C ZI P2 7 f 7'
#(h a ) 7 9-G 5 (Fax#( ) Subdivision
ized Agent City ZIP
,d ❑CW CIEW CJPTA ❑ES ❑PTS Phone# ( ) River Basin Zt.,r„_
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ Pws: ❑FC: Adj.Wtr. Body,54/2 C jc 71/4 fe r ,4e2 cGt
yes/na PNA yes / no Crit.Hab. yes / no
Closest Maj.Wtr. Body /9/4-✓�„/
_-
of Project/Activity ZQ p Lg c. e EX,,S 71/ j lfrL ) P 9 a P , e 4
/ (Scale:/ 1
lock)length /1 )(
S. 7 s 0')1/9 / ' -t ---5 1- 1- . -l4 e 72 r tJ e,t --..---i-
pier(s) I
length ND/ .
- - E-,,S ..j C2;:2• �ir�
lumber
a ad/Riprap length I
,vg distance offshore
j •
nax distance offshore 1 R
channel j M0
ubic yards
i
amp
)use/Boatlift
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Bulldozing --- l); _ _
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iJ 4. ki a ti IL
ine Length /0� --/- lf/ U' i (!I
not sure yes ` ..._
igs: not sure yes no
)rium: n/a yes I
Yes
n u l /
Attached: yes �+ 7 , Z vC 1 Pr D/I,,
ling permit may be required by:K2 y rf G,W i e/l C0.1,_ 7l y n See note on back regarding River Basin

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DIVISION OF COASTAL MANAOEMENT-
AWACENI RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: Foi cs
Address of Property: 34 Vvc., �,L� d I)t.
(Lot or Street #, Street or Road)
SPvvntic Co.
(City and County)
I hereby certify that I own property adjacent to the above-referenceci.property. The indiN
applying for this permit has described to me as shown on the attached drawing the developmen
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 Cc
Management,. 127 Cardinal Drive Extension, Wiltniugton, NC 28405 or call 910.395-
Nithin 10 days of receipt of this notice. No response is considered the same as no object
you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu
et bck a minimum distance of 15' from my area of riparian access - unless waived by m
,ou 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.
•
f4,e.
:i Name ( Date •
Vor si0,>73o , ) /L.10 . AAA

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
he purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
idividuals listed below. The LAMA General Permit application procedures require that applicants provide the Division of
oastal Management continuation that a written statement has been obtained signed by the adjacent riparian property owners
tdicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
y certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
mtractor or other individuals acting as an authorized agent on behalf of the applicant.
his form was sent to you by the following individual or company designated by the applicant as an
uthorized agent: n�� �O
2), ce„,,,..„..„ z-/-2,5?-0 2
.ut tori ed Agent's Signatur Date
acne of Individual Applying For Permit: C�, I . LOS,"
ddress of Property: i 2g(- River tieAd I .
(Lot or Street 14,Street or Road)
SkQ l/O7t.e bro)sd66 Co ,
(City and County)
iereby certify that I own property adjacent to the above-referenced property. The individual applying for this permi
is described to me as shown on the attached drawing the development they are proposing. A description or drawing
ith dimensions,should be provided with this letter.
I have no objections to this proposal.
you have objections to what is being proposed, please write the Division of Coastal Management, 12'
ardinal Drive Extension,Wilmington,NC 28405 or call 910-796-7215 within 10 days of receipt of this notice
o response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back
inimutn distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive th
aback,you must initial the appropriate blank below.)
I do wish to waive the 15'setback requirement.
'4/ [ dyZ not wish to waive the 1 5'setback requirement. Ar.PrA