40424D - Fogleman

CAMA I IH DREDGE & FILL N? 4
GENERAL PERMIT Previouspermit#
(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 4-I , I Lam
jrRules attached.
t Name LO‘AZ) Fo 6-Le MAC _ Project Location: County ..,D E.rL
(01. (-A as r'►,i s L R I ✓el - Street Address/State Road/Lot#(s)
f501-L $EFt4u StateWC. ZIP ZS`ISI}S.' IjOL c._WA,...).-EL 151va
6__w 32.2. Ica? ) Fax# ( ) Subdivision
ed Agent 4 A L. PO js L E M A fa City 1 op61.1jt.._ &EA L-q ZIP 2.81($
❑CW �EW "(PTA ❑ES L PTS Phone# (96b )SzZ • 1021 River Basin e,40k
❑OEA ElHHF ❑IH UBA ❑N/A Adj.Wtr. Body KAr K-S LHk1w,-'L Q/1
❑ PWS: ❑FC:
yes CO PNA / no Crit.Hab. yes / no Closest Maj.Wtr. Body AI v\/‘✓
f Project/Activity 12,414,,,�r4,_ 57r p b 4 '✓S o.... 6 vi j t.w.4- "oC 1— r 1A.)57&1 Li
213 floc .g- . I ,Y ri L (Scale: f 1=3
ck)length
i(s) to X 3 0 RANk S (JIb tiruCi
ier(s)
ngth 1)'X 1
tuber , j3.L.
d/Riprap length 6 (..1.. i L I
distance offshore
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cannel
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Dic yards
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is"421711 ! i
ulldozing
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of stma yes no
s: not sure yes p
cum: n/a yes P t—
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yes to
kttached: yes
ng permit may be required by: I aP S t7 ZL F. Erq c-.j4 . See note on back regarding River Basin ri

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GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: 1, s,'.1, G' 0''A
ADDITIONAL NAMES: H Foe, L e r A t—)
AEC DESIG: &►"/ PTA A DEVELOP AREA: PROJ DESC: —
(Will only take 6) (Will only take 1)
WORK: F 3J
(Will only take 4)
(SL. 13 , ► 3
MAINT:
(Will only take 4)
IMP: 0" —S`J ')
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED:
CAMA MAJOR DEVEL REQUIRED:

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROP RTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: L D v( 5 fa gGe.,•.t,Q,.1
Address of Property: l/a a- C Ji a.n -/ 8 (vd •
(Lot or Street#, Street or Road)
T--(v--i_4;- e fi)_e_,4.er._ __•„oc_cr- _ _
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit 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 Cardinal 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 by Certified Mail.
WAIVER SECTION
I understand that a pier, dock,mooring pilings, breakwater,boat house or boat lift must be
set bck 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.
/cCf do not wish to waive the 15'setback requirement.
sie Nalne , 7-1"--'—`
Date
. -1\----C2,.•/— ATA
Vrint.ham �,.—

OMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY „-
GUARDIAN A SAFETY OC'larke Amer..;AH
items 1,2,and 3.Also complete A. Signature
estricted Delivery is desired. ` 0 Agent
name and address on the reverse X' All.. ❑Addressee ' ';�/i!////
can return the card to you. B. Recei ed b (Printed N. e) C. Date of Delivery 1
card to the back of the mailpiece,
`ront if space permits. 'L" �S
D. Is delivery address different from item 1? 0 Yes
•essed to: If YES,enter delivery address below: 0 No ,1
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�� -.-JC /D 0 Registered CI Return Receipt for Merchandise E... 'Ip 1 '
' C/,j4 0 Insured Mail 0 C.O.D. - ru �,,
4. Restricted Delivery?(Extra Fee) 0 Yes • 9 ` (�!/
7003 3110 0000 2146 5072 ,1
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1 1, February 2004 Domestic Return Receipt 102595-02-M-1540 W ` .N
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