43222D - Berne

ICAMA/ --DREDGE & FILL r
3ENERAL PERMIT '_(/ Previous permit#
New Modification I Complete Reissue 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 I 5A NCAC 7/4//e
IThRt"fes attached.
t Name 4`41 6/11 t Project Location: County hdirlrv,'ci �t .
3O ,,,'✓o•-` 4: Street Address/State Road/Lot#(s)
►,, 1doetf State 4'k ZIP 2/c/-4/ . ..ole
(/O)279-3027 Fax# ( ) __ Subdivision
ed Agent _ City _ ZIP
❑CW LP EW L4'P`fA £S 1 PTS Phone# ( ) River Basin 65,4e
❑OEA ❑HHF Ill IH UBA N/A Adj.Wtr. Body t/,If��sr 40,a4r
❑ PWS: ❑FC:
yes / no PNA yes �n Crit. Hab. yes / Closest Maj.Wtr. Body _ YAr 0*
Project/Activity Arty0yce t �v/AAl.r'a
(Scale: /�y
:k)length
(s)
er(s)
nber
Xprap length Ila
distance offshore i i
x distance offshore
annel
iic yards - 1
P �C f
se/Boatlift "� .,_
illdozing
Length 2'6 )
not sure yes 49
not sure yes
urn: n/a yes
yes
ttached: yes t
ig permit may be required by: (5/r/h�j1,4;l,L'�j See note on back regarding River Basin rt.

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DIVISION OF COASTAI.MANAGEMFN-t
ADJACENT RIPARIAN PROPERTY OWNER NOT IFICATION/WAIN-FR FORM
Name Of Individual Applying For Permit ri v£L / cke/t
Address Of Property: Rrv€i Dk
•
__)e^ii i/lPe °77/✓e N.5
(Lot or Street#, Street or Road, City &County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
V. _I have no objections to this proposal.
If you have ohm inns to what is being
pnaposed, please vain- the Division of Coastal
Manafement, 127 North Cardinal Drive; Wiimin,,nn North Carolina_2g4C15_orrall 910 395-
1900 within 10 davc of receipt of this notice No retpans is ronsidere Lthe same as no objection
if you have hen notified by Cerrified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian arr'cs unless waived by me. (If you
wish to waive the setback, you tvirst initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
CT I do not wish to waive the 15' setback requirement.
4#110,1C. , /7/Z//25- A7191iriA
Signature Date

: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
ate items 1,2,and 3.Also complete / A. i'n. e .
if Restricted Delivery is desired. X , k ■ Agent
Dur name and address on the reverse ddd • Addressee •
we can return the card to you. �, g eceiv- • (Printed Name) C. Date of Delivery
this card to the back of the mailpiece, v /Z -.3.--dr- .
he front if space permits.
D. Is delivery address different from item 1? 0 Yes
\ddressed to: If YES,enter delivery address below: ❑No
CV: 116.K TA. 7-2i y
p 3. Service Type
M G e t)i L L E� Sc.- 029`�O J`� ®Certified Mail 0 Express Mail
❑Registered 14 Return Receipt for Merchandise
- 0 Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
Number 7005 0390 0006 6808 4743
I,from service label)
3811,February 2004 Domestic Return Receipt 102595-02-M-1540 I
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