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CAMA/ ❑DREDGE & FILL ,-
GENERAL PERMIT Previous permit#
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
>rized by the State of North Carolina,Department of Environment and Natural Resources 711.
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Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 1
liaRtiTes attached.
it Name el (13// G CiII?CJZ Project Location: County 3#2ti.�.s 4✓, e iC
>L,• t�1✓317 a e r.✓,,71,,( CCb ),2 R., Street Address/State Road/Lot#(s) // 19 ►
A t isj i Ai l le.,,, StateI C ZIP_2 17�// ..?) , /
(lei)) 4►, /-/'G y Fax#( ) Subdivision CA) /A ptf `j G2lil ,of
zed Agent_.3-0 4,s/ 169 2 ivy4 City C/a /& 9S I ZIP 2,2r%
❑CW DEW Br ❑ES ❑PTS Phone# ( ) River Basin I y,.r,
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body CA/Ri/f £, i i ,2 .0.
❑ PWS: ❑FC:
yes no PNA yesc` Crit.Hab. yes / no Closest Maj.Wtr. Body �/W
f Project/Activity FQ ,U Pi e Pi to 2 /.> C.
(Scale:/
)ck)length 2 t /)( y 'j h/a7.9 /6 'J�[V' l .T
n(s)
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ember I
id/Riprap length i '
,g distance offshore
ax distance offshore C-+ [l Qfr" �J f
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hannel —
ibic yards
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use/Boatlift Ion
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J 44 r
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1e Length
not sure yes c i
°
;s: not sure yes (
rium: n/a yes _.- j
Yes L _ — ' 1
Attached: yes I I '
ing permit may be required C.by: A/ 09,1 9S A I I See note on back regarding River Basin r
am
4625
DL 869
DL 8695114
66-1215/531
Date 840
4✓/e_ I $ 26°
o'- Vad Dollars In
.k.
/1
3000 24848 311'0 6 2 5
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: JU 16k) t`►�
Address of Property: ( 3 c1 �� d R(. O 2 ,
(Lot or Street r, Street or Road)
Chi$AkoAt. INI, C , gAlto%
(City and County)
I hereby certify that I own property adjacent to the above-referenced.property. The indivi,
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this letter
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management,. 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift musi
set bck a minimum distance of 15' from my area of riparian access -unless waived by me.
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 requirement.
am).-c•_) ii/ 370
Sim Name / Dat
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( I 39 R:kew j2, CIAiAv.) 1„ , (\(',c . (033 \\Ake Shone DR ,
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NCDENR
North Carolina Department of environment and Natural Resources
Division of Coastal Management
Wheel F.Easley,Governor Charles S.Jones,Director William G. Ross J
Authorized Agent Consent Agreement
is hereby authorized to act on my I
(Printed Name of Agent)
order to obtain any LAMA pormit(s)required for the property listed below. The authorization is limits
ecific activities described in the attached sketch.
)CATION OF PROJECT;
139 12Jv4f a)
COPERTY OWNER MAILING ADDRESS:
/ 5—7-a .44 /2,-e--
_.. . ( PHONE NO. WO 6' / — /4 U ''
THORIZED AGENT MAILING ADDRESS:
O h tJ A RrJ kw�
" S S4rpt f_ .0 klcl
PHONE NO. _I [0 - -7 (o
3N1]031,00 J. 010A'SS3HOOV NHnl3hi AH1
1HOIH 3Hl 0/3d013AN3 d0 d0111,H3HOLLS 33Vld
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. �� El Agent
a Print your name and address on the reverse X% c-L T r ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece,
or on the front if space permits. 7 C!r V-7-- - A 7C 1/ 23 C 2
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: • If YES,enter de ive addresp,below: ❑ No
-., C e X-. ILn \---- w co
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113n �l.l)
Csk.\cam , \\\Q_ gsclla%' �N
3. Service Type
ertified Mail El Express Mail
vRegistered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7007 1490 0003 0316 7385
(Transfer from service labs i)
PS Form 381 1, February 2004 Domestic Return Receipt W2595-02-M-1540