43996D - Groff

,CAMA/ DREDGE & FILL Tr?f-
3ENERAL_ PERMIT Previous permit#
4".Jew Modification lilCompiete Reissue Partial Reissue Date previous permit issued
-ized by the State of North Carolina,Department of Environment and Natural Resources JJ,,
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC ) T►• j O
❑Rules attached.
t Name T c - 2.a r Project Location: County ��j L �✓
5 pa L v i L v,/ Street Address/State Road/Lot#(s)
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oP.s�.t. 3�Ai N Stated L ZIP �-t3`�1100 'r t. V Z,Pi
( ) Fax#( ) Subdivision ��►�,N
edAgent .k1-1-v (3S ! Pr\ City N. ZIP 2,S ii
❑CW ,W 1JTA .IES ❑PTS Phone# ( ) River Basin'vigsf t.
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body` I
❑PWS: ❑FC:
yes /� ' PNA es no Crit. Nab. yes / no Closest Maj.Wtr. Body }.A�/(7)
Project/Activity 1 J ALL (L -� 1 Z�Z<� +�C),N,N ' \\ ><
L.."T c- (Scale:/
ck)length Le X 3 3 J
�(s) I L x
ier(s)
ngth
tuber
d/Riprap length
distance offshore
x distance offshore
cannel
2d
sic yards 114
rt.n
P S .
ise/•6oatl' 11 1-l
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ulldozing
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e Length I P •
(not Sum, yes no : - 4
s: not sure yes no
cum: n/a yes
yes
kttached: yes
ng permit may be required by: �� s �1 � t= See note on back regarding River Basin r

r:1` PILINGS AND MORE _,
J JOHN CASSIDY 4323
PH: [phone]
169 LAKE HAVEN DRIVE ---' --/( 66-30/531
SNEADS FERRY, NC 28460 Date .--?/—r.c c7 ` 457
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BANK FiruCLtizens Bank 8 Trust cm"""
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�r�,1` SnoaW Perry,N.C.28460 / /
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08 06 0753p Don Groff 919-326-3572 p4-
1EC-16-2005 14:55 From: To:919 326 3572 P.1'l
DIVI§ION OF COASTAL MANAGEMENT
ADJACENT RIP 1AN PROPERTY OWLs7cANOTEFICATIQNWAIVER FORM
Name of Individual Applying For Permit: e,ri al V e v0V
Address of Property: > i e w e t'il
(Lot or Street#, Street or Road)
, _ �1 I
110�tp 2Fsq C.C1 n. c. (CA-)Sjo(-1) Boon
. (City and County) •
I hereby certify that I ova 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 cr drawing,with dimensions.,should be provided with this letter.
I have ao objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 2840S or call 910-796-7215
within 10 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 a pier,dock;mooring pilings, breakwater,boat house or boat lift must be set
bck 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.
X I do not wish to waive the 1 5' setback requirement.
Sign Name Date
ae( reex\wctil V'
Print Name A
�q - 6 + q507 NCDENR
Telephone Number with Area Code .perPlabouterts
.

08 06 07:52p Don Groff 919-326-3572 p.3
:C-16-2005 14:55 From: To:919 325 3572 P.1':
DWL ON OF COASTAL MANAGEMNT_
ADJACENT'RIP AN PROPERTY OM EB OtIFICAO34l/WATVER FORM
Name of Individual Applying For Permit; on (1)• 8 6 r
Address of Property: - Sql1 1) t
(Lot or Street#, Street or Road)
floe- -Tpsq F3 M ) ( oris10 coo,
Z
(City and County) •
I hereby certify that I ova 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. AA,escrirtion or drawing,with dimensions, should be provided with this letter,
J� v
I have no objections to this proposal.
If you have ejections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
within 10 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 a pier,dock,Ymooring pilings,breakwater, boat house or boat lift must be set
bck 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.)
[ do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement,
SETL lAel I -�,— /— —��G
Sign Name Date
iPrint Name
boy rye• 7 NCDENR
Telephone Number with Area Code W «
R Iou-ac.
A