41477D - Cerwonka

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.AMA% Li DREDGE & FILL -' .::
ENERAL PERMIT Previous permit#
Jew Modification Complete Reissue -Partial R ssue Date previous permit issued
:ed by the State of North Carolina,Department of Environment an Nat al Resources
iastal Resources Commission in an area of environmental concern p rs nt to I 5A NCAC MI. 11lV, 716 tt11111 Rules / O, 7?
Name Tiotrict f, C.te'biohk4 Project Location: County /d«m eCt,✓ 6,
655" ,ilk U vy 40a1 ypbl._ Street Address/State Road/Lot#(s)
t , 5#e401
State Ile ZIP 21043 46ent
;gfio)Z 70-71)02 Fax#( ) Subdivision
:d Agent City ZIP
❑CW 'W i3PTA lAitt ❑PTS Phone# ( ) River Basin /10e ,
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body /Ntr1/4441e eit„a/ IA (nat it
❑ PWS: ❑FC:
/,�n� Closest Maj.Wtr. Body / Aga
'es / {o) PNA yes / Crit.Hab. yes /�fio^.'• / / //
Project!Activity /i-d eSd hPA-1' /i At/ /.)i.1/-, .biJ/AAeRAi I /apt./ liCSs.,
(Scale: / H=
:k)length /O X 6
(s) 1
er(s) 1.44—HQMt� cam Ai Gl9hNed-bsi' 'I-D /1-ikild
igth
nber
:kiprap length 44
distance offshore 'G
x distance offshore
y_ /flx G { l�
cannel /�X ✓ /, ;St;„l t)l.f T T*✓d"
)ic yards O o h e
rip \ /
is Boatli /3)C13 i'r C4—'• iisA a4vi.iiii'
1 i \ it��' /a6:
ulldozing 0 /54 ! 0 0 ,��j
'LAISrr.11r.e
`5 V
,
c/
ie Length 7 V• /
not sure yes 5 J kt kor/ bin}- .
;s: not sure yes
rium: n/a yes n
yes n
Attached: yes n [}
ing permit may be required by: PQr1 4/ C), . See note on back regarding River Basin i

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 4-101 n S . C e
Address of Property: a s S )-{i c L, i2 (Po i, - RD.
(Lot or Street #, Street or Roadr
(ct►n(' S3-ec.S Pe-I be(' C OLln r
(City and County)
[ hereby certify that I own property adjacent to the above-referenced property. The individua
ipplying 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.
[f you have objections to what is being proposed, please write the Division of Coasta.
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 is
Jou have been notified by Certified Mail.
WAIVER SECTION
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. (Ifyot
vish to waive the setback, you must initial the appropriate blank below.)
f'r I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
eict4L qy2gt„vie)ec
Sign Nan( Date
_ __ _ _

OMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
items 1,2,and 3.Also complete A. Signature
iestricted Delivery is desired. X �j/• ) / �I y❑Agent
•name and address on the reverse Vieth let/ _L �, is^ 1. TJ Addressee
a can return the card to you. B. Received by(Printed Name) C5D..,of Delivery
s card to the back of the mailpiece,
front if space permits.
D. Is delivery address different from item ? 0 Yes
Pressed to: If YES,enter delivery address below: 0 No
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J of CL� Lriceified Mail ❑Express Mail
2 �4/73 Registered ❑ Retum Receipt for Merchandise -®T —
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Mail ❑ C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes r■•ti m D
nber 7005 0390 0002 4358 8185 remit w )j1 330
om service 0,
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$ n
11, February 2004 Domestic Return Receipt 102595-02-M-1540 . f3 p- O 3 O .s m
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OMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY tJl 1 § a
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items 1,2,and 3.Also complete A. Signature ., a
iestricted Delivery is desired. I- ' gent ,O a Z
name and address on the reverse ftli! �Z�''f4 dressee in -4 0 g
e can return the card to you. b. Received by(Print ame) C. Date of Delivery —a ,A ro ) t�
s card to the back of the mailpiece, r'.// <' R 5 o
front if space permits. 0
D. Is delivery address different from item 1? 0 Yes O w '
Pressed(( to: II,, 1/��n l I,, If YES,enter delivery address below: ❑No v\
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z $ w 1
Certified Mail El Mail � a
❑ Registered 0 Return Receipt for Merchandise L.11
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❑Insured Mail 0 C.O.D. C7
4. Restricted Delivery?(Extra Fee) El Yes .
it
nor 7005 0390 0002 4358 81,78 ` i
rim service label) ) ,
11,February 2004 Domestic Return Receipt 102595-02-M-1540
o 0
ostal Service,. o
IFIED MAIL,M RECEIPT •
a 1 Ip
tic Mail Only;No Insurance Coverage Provided) a c
-ry information visit our website at www.usps.com.,; U.S. Postal Service,,, t
PsPfc 080 CERTIFIED MAILTM RECEIPT
i rl (Domestic Mail Only;No Insurance Coverage Provided)
Postage $ $0.37
0405 For delivery information visit our website at www.usps.com
:ertified Fee Ili /�
5 Postmark ul I Q0 IC C 4/7 I A L U S E
Receipt Fee Here M .-