41504D - Guy

(.LAMA/ [-DREDGE & FILL N?
3ENERAL PERMIT
Previous permit#
4New -Modification Complete Reissue Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC N• I33
tRules attached.
it Name b wpq (, <3 Project Location: County 01,5►, t/
'-\1 J\ Street Address/State Road/Lot#(s)
uA I_ State NC. ZIP ntiGO I 3L0 01 sr
`( ) Fax#( ) Subdivision0 I 6-err L S
:ed Agent j'T Oa IL1 Pn F S I City \/ ZIP 2� & (o<<
cw )w ATA AS ❑PTS Phone# ( ) River Basin.A t
OEA ❑HHF ❑IH UBA ❑N/A Adj.Wtr. Body LAN)AL_ 51141"9 Sew
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PWS: ❑FC:
yes /� PNA yes / no Crit. Hai). yes / no Closest Maj.Wtr. Body �Z ' V✓
F Project/Activity 12s P LAL t c j -e
(Scale: l I
ick)length ,
n(s)
>ier(s)
:ngth >
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id/Riprap length
g distance offshore
ax distance offshore -
hannel
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ise/Boadifc
tulldozing
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not sure yes P L P L
s: not sure yes ©°
rium: n/a yes Q
yes 'l7
Attached: Zap no
ing permit may be required by:51.1&P 67-7"1/4/ I See note on back regarding River Basin r

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ay 02 05 03: 50p A. D. GUY INS. CO. [phone] p. 4
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNERJOTIFICATION/WAIVER FORM
Name of individual Applying For Permit: 40macitt / - //1 /%16d. l.�'J/`�
Address of Property: `05: " /'f't Jr §T` f6rTiE2 3 etk y6 tit- f17
(Lot or Street 4, Street or Road
-Nr."1:- lila /4). oAki&Lki (e.. 0.4 t>,
(City and County);-
1 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 descriptionti or drawing,with dimensions, should be provided with this letter.
X \/64k 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
understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift must be set
bek 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.
I do not wish to waive the 15'setback requirement.
frA
Na e 1 5 Date •
l / A w ?f'1 . . . . .- if

ay 02 05 03: 50p A. D. GUY iris. co. [phone] p. 2
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN J'ROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: - /�.,N Xy e /J 1- r Ir.h �' ({`)
Address of Property: `°r: ? /r'` kfri rxT f Q fF fl .E't 3 i�I r� c� t l r7
(Lot or Street II, Street or Roads
(City and Counly);-
•
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development l I icy
arc proposing. ik.lescription or drawing,with dimensions, shoulJ be provided with this letter.
3r1`d 771r
�l 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
lick 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 'setback requirem -
1 d not wish to waive th 5' setback requirement.
Sign an e i (Date) 46,77A

SNEADS FERRY, NC 28460 66-19/530 �/
[phone] f '
PAY TO THEN, C 0, Are $?#0 t
ORDER OF
/ aca OGcor-
iAUTH/os-- IGNATURE
MEMO
�/J v S4/J o3
00046940 17.0 5 3000 L 9 6i: 000 6 50 5 2 L 9 90o