43267D - Breese

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_CAMA/ DREDGE & FILL qtr
3ENERAL PERMIT Previous permit#
-New _ -Modification Complete Reissue -Partial Reissue Date previous permit issued
rized 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 . i Loo
X Rules attached.
t Name NAB 6 mac- E 5 z Project Location: County ©)S L k.......
L0.3 L %-t Awe/1 c \d- S H c 5 Street Address/State Road/Lot#(s)
.ii.Ab,, 1'c.La.'j State►JL ZIP ZSH(c (�3 ciHihb.v.iLL►L 500r2_-tt-
`(5`4 Fax#( ) Subdivision 6-IAA;•- .N I L it._ S N,mot, S
;ed Agent 'o v`a1 ST . City So C A,>S G¢R.rt..y ZIP Z-%‘1 I
❑CW >OW 'TA ❑ES ❑PTS Phone# (Ci )532- y 2q"1 River Basin %/AT► C.
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
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❑PWS: ❑FC:
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Project/Activity Z a s-f"A A-f- 5 A 84040 \>-L c& A,. "S x 1 Z. H r t,N1 • $x I co F
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distance offshore E _ g
ix distance offshore 2 if. ,
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aic yards t p•
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not sur' yes no L. i i
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yes _ -- i P r...
kttached: yes ia7 __ _� __ , _._4..
i
ng permit may be required by: C)NS ►-J✓ G,-..) . _!See note on back regarding River Basin r

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DIVISION OF CO ,STAr MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTlI ICATJON/WAjVER FORM
Name of Individual pplying For Permit: 1-0(1_,Le_
Address of Property:P rty: L6A-1,f-P/�
t or Street#, Street orFO
Road)
ity and Courtly) ,
I hereby certify that own property adjacent to the above-referenced property. The individual
applying for this perm.t has described to me as shown on the attached drawing the development they
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 Coastal
Management, 127 Catrdinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
within 10 days of receipt of this notice. No response is considered the same as no objection if
you have been notified I by Certified Mail.
WA1VEg SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
set Tack 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.
_ T lo not wish to waive the 15' setback requirement.
/6/6 6--
Sign Name Date
n, d 4- ATA
Pr nt Name
_ — Q- q6-0 NCDERN
NORTH Cule$41{. GI

ROBERT MILLIS
P o Box 1122 119{_'
.313 OLD FOLKSTONE RD •
•-�� . i��S • 66-30/531
SNEADS FERRY, NC 28460 Date G' 457
7 ..
Pay to the � ��� /
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(h det olf /� J( �' // I $ K'(�r�'�J
/ /� e ;; 'C �,-l��( `-1 e I)r,llarti_. 8
FIRST CITIZENS
451 >
'
61 F onsBank8Tr Company 4
SS K Snoad,Fo 460 `J �vww.(irstcitizens.corn ;- -/, ,Fl - :---,_-' ____/ 1 --. r -./'' e"..:;-- , ',
1:053 L003001:00457750509511' O L L9 2
Oc'In n,.r..ka.' _ rntk ♦I.. , -. .' 1' .,,`aye,,. ENOLG9@041AC6'•WIG e
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signatu
item 4 if Restricted Delivery is desired. _ / 0 Agent
• Print your name and address on the reverse X 0 Addressee
so that we can return the card to you. B. Received by,(Printed Name) C. Date of Deliver
■ Attach this card to the back of the mailpiece, /` /� 1
or on the front if space permits. ' (v� ,e41,1 ,/C 0
D. Is delivery address different from item 1? 0 Yes
1. Article Addressed to:
If YES,enter delivery address below: 0 No
71-��' en l'o tat('e 10
R0 7 rr- v 7c 574- 3. Service Type
� ^, 0 Certified Mail 0 Express Mall
7 C/'i, Wr 0 0 Registered 0 Return Receipt for Merchandise
rY �, ❑ Insured Mail ❑C.O.D.
V �0 790 4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7004 2890 0003 7346 4014
(Transfer from service label)
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540