43289D - Warlick

'LAMA/ _ DREDGE & FILL
3ENERAL PERMIT Previous permit#
New Modification _]Complete Reissue E Partial Reissue Date previous permit issued
-ized by the State of North Carolina,Department of Environment and Natural Resources ^�
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /19. /2 6 0
T [•RUles attached.
t Name L, .1�), Jana- Is4k TTZ, Project Location: County g2 a vJ h/" C JC
dcIL' !".€c 2S , _ Street Address/State Road/Lot#(s) /ZQ L/G,'J
, CQ LN1'.✓ State' — ZIP 2 10
(2 2Jr400 f Fax#( ) Subdivision
ed Agent e L /k L 4¢f S CityA ICIO"-.600 cIi ZIP 2
❑CW CHEW L PTA 8ES ❑PTS Phone# ( ) River Basin Ld.Itv 4
❑OEA ❑HHF ❑IH ❑USA ❑N/A Adj.Wtr. Body(> ✓Al L aolf"4 /G✓h/ (nate
❑PWS: ❑FC:
yes /�_ PNA yes no _. Crit.Hab. yes / no Closest Maj.Wtr. Body e1 i✓
Project/Activity of ISM a✓ C CA.s 7', r) )0 c k � 1 ie / / # cA
(Scale: I 97
:k)length ,13c b' A^+p
(s) 9'x /i'6 "
ier(s)
ngth
Tiber
1/Riprap length _—
+ i
distance offshore
x distance offshore
.
cannel
i
)ic yards
ip
se/Boatlift
illdozing I
C`0 f/ 7'X /L
a Length
not sure yes or
;: not sure yes ono
cum: n/a yes %1730
yes 5j, ,; ::,r. �; •�1tached: yes --. _
ig permit may be required by: Pe 1 of S.Y' 64,174 4 Pi See note on back regarding River Basin rt

WESTERN'I 'MONEY_ INTEGRATED PAYMENT SYSTEMS, INC.-ISSUER
UNION ORDER Greenwood Village,Colorado
08-417372328
AGENT 343;_ DATE 011906 1
82-40/1021
TIME 1401 02
** PAY EXACTLY ONE HUNDRED DOLLARS AND NO CENTS **.***Z****:*
PAY EXACTLYPAY TO TCH i/� �' �//�
ORDER OFE /►i l,�G 4+� ! ` tD4{ l/5EO6_AACt i'
7r �((��jj'//nn''YtS4Py►f�Q�A$ER�iA✓D3L /_fitii'ai IJC {y '�1X
yVURCNESEP.SIGNER 0
✓✓ RYRLW SEA 9Y$IGNINa YOU AGREE TO THE TERMS ON TIE PEVEPSE SIDE.
Western Union Money Order and Design is a service mark of Western Union Holdings.Inc./Payable at Wells Fargo B$rr a'rancl Juncton-Downtown.N.A..Grand Junction.Colorado
LO 2 LOQ 4001: 4008 4 L ? 3 ? 23 2880 L- D . 1. 'l,cic �.-
_ 3.2X, 1 t 5 Two
L•r.c�•In to.T , NC_ Z

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/\VAIVER FORM
Name of Individual Applying For Permit: cf, L Cll?X1e_7 L
Address of Property: I oL LA'YL, PCLL,Q- PA
(Lot or Street#, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development t
are proposing. A description or drawing, with dimensions, should be provided with this letter
-14OA- 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 objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift must bi
bck a minimum distance of 15' from my area of riparian access-unless waived by me. (If
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.

•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONiWAIVER FORM
Name of Individual Applying For Permit ;, tt 1 C'Lt .Q Le',c 9.
Address of Property: 1.;/C
(Lot or Street 4, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tl
are proposing. A description or drawing, with dimensions, should be provided with this letter
have no objections to this proposal.
If you have objecti ns 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 objectio
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
bck a minimum distance of 15'from my area of riparian access-unless waived by me. (If
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.
AMA

Locality Permit Number
GENERAL INFORMATION
LAND OWNER
Name tp, Oct)) k 1 4 ,
Address /1 C( Lo t , /� ,
City( �u►k LCQ+nk._ State ))(i Zip C 942 Phone
AUTHORIZED AGENT -}- -�j/�r��"� � /
Name S cY 0_aYI,N f �►M �C �C.�K..61-L
Address n9n �� ypto � C 1/1- • sr
CityPQ J State AL Zip ViyoU Phone WO `?1 96
LOCATION OF PROJECT /027) d Pam-
(If not oceanfront,is waterbody natural or manmade?)
DESCRIPTION OF PROJECT
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline
PROPOSED USE
Residential Commerical/Industrial Other
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT-UPON SURFACES (such as driveways, etc.) within 75 feet of the estuarine shoreline, or 575
ORW shoreline, or 30 feet of the public trust shoreline.
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING
SQUARE FOOTAGE OF SITE
OTHER PERMITS MAY BE REQUIRED: Zoning,Drinking Water Well, Septic Tank
(or other sanitary waste treatment system),
The activity you are planning may require Burning,Electrical, Plumbing, Heating and
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