48241D - Land

CAI1/IA/ ❑DREDGE & FILL
3ENERAL PERMIT Previous permit#
)New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina,Department of Environment and Natural Resources -7
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC / o
lAV IQ 'Kules attached.
t Name 1 f1 E , L A j PUJ}E_(AD.— c-.Project Location: County 11E1)Uii —
Vr, n)C. 106CI Street Address/State Road/Lot#(s) I_-I I A Or- 1C
1:APAI TV, State N(- ZIP 2S1+6 A(QES llzA"`t7 -• 44-0GlicS i2.0
(3j ) Fax#( ) Subdivision W/h I kAel)j.1 At tS
ed Agent iyA f 1 .. C tkL ENTc City VbfkII 1 pci E7 J) ZIP L,S y t-1
❑CW PEW I1A ❑ES ❑PTS Phone# ( ) River Basin (ArdS
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (\1 ILL_ C I -tU -- ( a�n
❑PWS: ❑FC:
f ! no PNA Closest Maj.Wtr. Body A k W V\/
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yes / g f) Crit.Hab. yes / no
Project/Activity (-,'R c t P..) ( V i a-'y Lf CQ Cn rY111 ►J 11)0
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nber ) f 1 I. Z, 25' WAm
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gt { — � � �' �- 0�YY1 Ai 1,l 1t�LAN VVftTt,
distance offshore t 11 S' tte .IT' emu.. NCI
(distance offshore �_
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not sure yes n61 1
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not sure yes --
,m: n/a yes 1 LOT /Eralpr vi ro !
yes -- f WASH I Pe'113►J A Ie.CS 13o M� `1
ttached: yes tie.' 1 1 I 3_ It)Cat S 12D• I j. l -
g permit may be required by: '£Ρ-�}Q-ele_ See note on back regarding River Basin rul

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CERTIFIED MAIL -RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of individual applying for the permit: / 1- ,�ct � ,� igiteeir-L_
Address of property: /2 /e26 9
J'� /,(Lot or street#,street of road) ,
/ e , vCna r
pity&County)
I hereby certify the 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 whit this letter.
t I have no objections to this proposal
If you have objections to what is being proposed,please write the Division of Coastal
Management,400 Commerce Ave., Morehead City,NC 28557 or call [phone]
within 10 days of receipt of the 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, boathouse, lift or
sandbags must be set back a minimum distance of 15' From my area of riparian
access unless waived by me. (If you 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 requirements
Signature Date

..'.,.,_
IIII
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- h.,, -s- 34,
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Sign re
item 4 if Restricted Delivery is desired. ,/J i 0 Agent
• Print your name and address on the reverse X !�•
r�CI Addressee
so that we can return the card to you.
• Attach this card to the back of the mailpiece, B Received byTinted Na e) C. Date of Delivery
•
or on the front if space permits.
1. Article Addressed to: D. I delivery adelrass different from i em 1? 0 Yes
/,4l-///1-47 ,, I enter livery address below: ❑No
, # ,q
/ fi' /�! 1//v C 3. Service Type
j ///��� 0 Certified Mail 0 Express Mail
z"7Yf� ❑Registered 0 Return Receipt for Merchandise
0 Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number
(Transfer from service label) 7005 0390 0003 3402 9160
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
U.S. Postal Service,.
CERTIFIED MAIL,-M. RECEIPT
rq (Domestic Mail Only;Wi.*'nsurance Coverage Provided)
a-
For delivery information visit our website at www.usps.com
ru
Weert* fiCiALUSE
m Postage $ $0.39 0443
m
OCertified Fee $2.4I) 04
O Return Receipt Fee Postmark
(Endorsement Required) $1.85 Here
Restricted Delivery Fee
faTll (Endorsement Required) $0.00
O
Total Postage&Fees
u, 04/18/2007
o Sent Too
Street,Apt "4 �77 agee .7pj�
or PO Box No. %te i 12
City,State P+4 /
1i4 r�c
PS Form 3800.Ju.,e 2002 See Reverse for Instructions