42013D - Bachman

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'CAMA/ )DREDGE & FILL *•fC
iEN E_RAL PERMIT Previous permit#
,New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources /� Q
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
j�,� B /� El Rules attache .
:Name VGA /1CS ii t 4','14n Project Location: County //1441,, / di10
a t//3 /4411 /r , pu Ia9fis Street Address/Staten Road/Lot#(s) a�1/// d
V/� l 4h State /LC ZIP a Sys /a /2/fiC/ r S;se•sj'Z� /20✓.
( los) Gu * SS Fax#( ) Subdivision
ed Agent T oek, kat?*r s City ,Mie"i IPA ZIP /?���///1
❑CW [ TA r?!ES[ ❑PTS Phone# ( ✓✓) 'µ' River// Basin C 64
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body Ci 'r2A / Ci4,1 / (nat /t
❑PWS: ❑FC: /
e I no PNA yes / Crit. Hab. yes / no Closest Maj.Wtr. Body / ' { Si�'�"�
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L'Tdistance offshore L4• f8/i/
x distance offshore ; ) —_.___.,__—
cannel X 1s X..3, % iK ''.°
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ig permit may be required by: 4,i �D. . See note on back regarding River Basin 11

COASTAL EARTH WORKS INC. 3031
1955 MIDDLE SOUND LOOP RD
WILMINGTON,NC 28405 66-7172/2531
9 - 2 6 - e 5
DATE
PAY TO THE D., �
ORDER OF f I $ I od`D .
U
N OA)c 1-1u7'.4 r2A 1-- - DOLLARS 8r F::
COOPERATIVE
BANK
WILMINGTON,NC 4,.........„
(� r ',
5z::;._
FOR PC'rm!T4201, 3 Jam'''` �7S lJ� Nr
1: 253L7L7281: L69001030211' 03r031
OMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
items 1,2,and 3.Also complete A. S'•.ature
Restricted Delivery is desired. / 0 Agent
r name and address on the reverse A*. _ 0 Addressee
•
e can return the card to you. B. Recei -• •19 Printed Name) 'C Date of Deliwy
is card to the back of the mailpiece, _ ,
front if space permits.
D. Is delivery address different from item 1? ❑Yes
Tressed to: If YES,enter delivery address below: El No
Deter Mo?ley .
Willie Sot Avor Kot,
'-"r" ) Ai'C 1 v ` J 1 3. Service Type
❑Certified Mail 0 Express Mail
❑ Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
om service label) 7003 2260 0004 0396 6040
11, February 2004 Domestic Retur, _
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVE
■ Complete items 1,2,and 3.Also complete A. Signature
... item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse X i
. • so that we can return the card to you.
• INAttach this card to the back of the mailpiece, B Received by(Py {e_d Name) C.
or on the front if space permits. .J `�
1. Article Addressed to: D. Is delivery address different -•m item 1
____ . • 0 If YES,enter delivery address heinw•

YO MUDDE. T Coastal Earthworks, Inc.
1955 Middle Sound Loop Road • Wilmington, NC 28405 • Phone: [phone] • Fax: (910) 68R
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DIVISION OF COASTAL, MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit Cnr•l- irS ( ¢,., ( e,.j4" `rrnn1y L JA.f-Ft
2411--21-13
Address Of Property: 33'1'7 m ;kt fie 5,, Zc .p /2
GJtlw�/.� 4ar�: ) A),C. 2S4II
(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 to"i1 a 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.
prcigrN1 0NIy ,t
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 North Cardinal Drive, Wilmington, North Carolina_ 28405 or call 910 395-
3900 within 10 days of receipt of this notice_ No response isconsidered the same as no objection
if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, •.;- mooring pilings, breakwater, boat ' e me, lift or sandbags must be
set back a minimum distance of , •m my area of rip. '. : .•.- unless waived by me. (If you
wish to waive the setback, you must hut le . . opriate blank below.)
I do wish to waive the 15' setback -! irement.
I do not wish to waive the 15' setback requirement.