41536D - Green

rCAMA / DREDGE & FILL N9 4
;ENERAL PERMIT Previous permit#
;New 'Modification 1Complete Reissue Partial Reissue Date previous permit issued
ized 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 1 1/ . /, 0(1
Lis attached.
t Name 1 I I ee 6/F F r Project Location: County / it/kirk i IN I C/
(
I /70 't o ( Street Address/State Road/Lot#(s) 7 y /2764 4
4N 141 /3,ate Are ZIP 24 1/S /
( ) Fax#(/ ) Subdivision
edAgent �/f j Aar VA 7I - City 4, ,t/Y ) 1" Zip a D k i
❑CW q1719 [ PTA ❑ES i PTS Phone# ( ) River Basin t..414
❑OEA ❑HHF ❑IH 7 UBA N/A Adj.Wtr. Body (/1 v 4 ( 64 F 4 Wk."(nat e
❑PWS: ❑FC:
av
yes / no PNA yes / no Grit.Hab. yes / no Closest Maj.Wtr. Body 4/ Li
Project/Activity Kr p/E rxQ,•. / o/-` TAW 75 f`y c'c_e ( yi.) ') F 'v 1) A-.c-. A a^..
1 1+f -7C i✓16 S h l D o C r. (Scale: / 'c
:k)length
(s)er(s) x \ N l \_.J
igth „(la. �'", r�: 11
nber 0 Tk.\
I/Riprap length
distance offshore
x distance offshore f
annel O
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not sure yes 0 _ x-----
not sure yes
urn: n/a yes g �� 7 (1 �0r ,�' —yes
Attached: yes
ig permit may be required by: 0 C '-q A, -i/-P ___ -P fr/74 . See note on back regarding River Basin n

: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
tte items 1,2,and 3.Also complete A. Sign—,re ❑Agent
if Restricted Delivery is desired. X i ❑Addressee
)ur name and address on the reverse 14 / J
we can return the card to you. B. Received by(Printed Name) C. D to f DeltQery
this card to the back of the mailpiece, L jp )(c
he front if space permits.
D. Is delivery address different from item 1? ❑Yes
>,ddressed to: If YES,enter delivery address below: 0 No
DL.NrA Sk'C-- ____ .
)9 ? \)\ wcyafbc. 3. Service Type
Certified Mail 0 Express Mail
0 Registered 0 Return Receipt for Merchandise ■■ r- '{
z
S\„ e O{0 ) 1 C...., CI Insured Mail ElC.O.D. Lri
,
I 21 0n z
4. Restricted Delivery?(Extra Fee) 0Yes Ly
Num`-- n.] O
sr fro 7003 3110 0002 9510 3090 li ti
3811, February 2004 Domestic Return Receipt 102595-02-M-1540 1 L{u LI\ o 1.l (�
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property: 2 d^ Mot) ro S'
(Lot or Street#, Street or Road)
-e4n �� � kip/-c.h /.7 � ✓nSG-`C1i �_
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individw
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.
4,14 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
[ understand that a pier, dock, mooring pilings,breakwater,boat house or boat lift must be so
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.
ign Name Date

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