42834D - Camp

V li9D------- ,
,CAMA / DREDGE & FILL 1... 1
3ENERAL PERMIT Previous permit#
New Modification Li Complete Reissue lPartial 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 71 , /lOD
&Rel€s attached.
it Name /* /Q /J t. C/J� Project Location: County ,Pa Li,✓1 iv/ C.,,e
2 7/ J J 2 Per O w J 6142 ek/ are,- Street Address/State Road/Lot#(s) TI 50 A,.
7ilCL71/j./b Nnes stateti,,IC zIP 2l�.7117 ,511 Sr. le`�- S Z •2i2)ax#( ) Subdivision Sv„'se 7 ,9A2 1
:ed Agent L(Q`d frj/,S L _ CityEo 1 I v ZI P2 FYZ
❑CW PEW" DATA ❑PTS Phone# ( ) • River Basin Li/,I)
❑OEA E HHF ❑IH ❑UBA r N/A Adj.Wtr. Body/9/ AN 4/ atk
❑PWS: ❑FC:
yes /2 PNA yes /rG- Crit. Hab. yes / no Closest Maj.Wtr. Body �� ill Al
f Project/Activity R y LAc eft, r.-d o F £X u1, ., __mu L1-4 p c I
(Scale: / ':
Eck)length
1(s)
rier(s) ^�/ _ if) , Y" w r/' 't
:ngth �C P^d
!mbar I* ._. tI ,_
d Riprap length 5 e0 ;�
g distance offshore 2 �+ `+� .
ax distance offshore
( 8 e ,) h e'') V ).,
hannel /..1
bic yards
Jse/Boatlift
iulldozi
606004
re Length 40 v
not sure yes no r 1 —___ _-{/ 6
;s: not sure yes fio Q � f ;'J ri t'� ✓
rium: n/a yes no �1 0 I P '1
yes
Attached: a yes no ----
ing permit may be required by: Pot y,rf N/c 4' C P , See note on back regarding River Basin r

•
(ANT L.MINTZ 67-7235/2532 547
3522007687
846 WHITEVILLE RD.NW 910-471-2611 DATE
NC 28420
•
13 pc, 0/e_ is
BDER
•
l)(LLARS 8
•
Coastal Federal
—Bank •
SHALLO 28470, '
5327235 Si: 352200768711' 0547dr

V / fa/vs e71

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: <'
Address of Property: S u ,,, S'[ S-E,
(Lot or Street#, Street or Road)
(City and County) —
I hereby certify that I own property adjacent to the above-referenced property. The individu:
applying for this permit has described to me as shown on the attached drawing the development the
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 Coast
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390
within 10 days of receipt of this notice. No response is considered the same as no objection
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 sf
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yo
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.
Sign Name Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
\Tame of Individual Applying For Permit: /V / (T Zvi f .
kddress of Property: S 1 S AA sti/ 7 E
(Lot or Street#, Street or Road)
Eo IN 1i+ c
(City and County) —
hereby certify that I own property adjacent to the above-referenced property. The individua
tpplying for this permit has described to me as shown on the attached drawing the development the;
ire 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 Coasta
VIanagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390(
vithin 10 days of receipt of this notice. No response is considered the same as no objection is
Tou have been notified by Certified Mail.
WAIVER SECTION,/
• � L„ IM1iEad
understand that a pier, dock, mooring pilings,breakwater,boat house or boat lift must be se
)ck a minimum distance of 15' from my area of riparian access -unless waived by me. (Ifyoi.
vish 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.
,47 4 e t o 7 v/ �S
i gn Name Date
7