39793D - Hughes

CAMA/ E3"bREDGE & FILL
;EN ERAL PERMIT Previous permit#
New JModification -Complete Reissue JPartial 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 71 •//�•
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lielkules attached.
:Name 4%41 i49S /hr r.'4 Project Location: County y/4,0W.(44-
ie J jj,1/A ? j' . ir1 . Street Address/State Road/Lot#(s) 5
/A1/ . (J/ State /V(� ZIP 4 V
(q/tl )7S - 3b Fax# r✓-) ) 7 SV-GO 6 U Subdivision ed Agent ,41,q City S /41 '�j' " ZIP a /7
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li CW L EW ;]P'TA CrESr ❑PTS Phone# ( ) River B in Lv*)
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❑ PWS: ❑F�C: /�TwG1/4"
yes / no PNA yes / �o�J Crit.Hab. yes / no Closest Maj.Wtr. Body /�-�
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x distance offshore
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not sure yes19 1
s: not sure yes no
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Attached: yes 1 !/
ng permit may be required by: ��YAS AJ I Ci lA . 1 1 See note on back regarding River Basin r
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
blame of Individual Applying.For Permit: R 1 l � S a ►-N
Address of Property: 1\CZ ?4, t28
(Lot or Street#, Street oRoad)
(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 attache 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 910-395-39C
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 s
bck a minimum distance of 15' from my area of riparian access,;,unless waived by me. (If y(
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.
\\-J" L I
V
Sign Name Date
C ._ _ l 1 _ 1 \ .rn.

•
Form DCM-MP-1
APPLICATION
(To be completed by all applicants)
b. City, town, community or landmark
5hri// ;,j I
1. APPLICANT
c. Street address or secondary road number
a. Landowner: 0 i1 L 1/45 , ,1
Name ALL/son B, / Li5j1 e S d. Is proposed work within city limits or plane
pp jurisdiction? Yes y No
Address I ?co V ///f`,C POI n/ � e. Name of body of water nearest project (e.g. ri
City S/7 1 «v im State /4✓ C.
• creek, sound, bay) $h ra//o
Zip Cam► s Day Phone 9/0 -7 59- 365C
Fax C710_7 cc _ cl.16 O 3. DESCRIPTION AND PLANNED US]
OF PROPOSED PROJECT
b. Authorized Agent:
Name a. List all development activities you propose (
building a home, motel, marina, bulkhead,pier,
excavation and/or filling activities.
Address �' f'�?/,�,! ►- FRt S �� �J
5 /Gr Ii .zd4 (1t 0
City State `''
Zip Day Phone b. Is the proposed activity maintenance of an exis
project, new work, or both? i a /A
Fax
c. Will the project be for public,private or commet
/ use? C
c. Project name (if any) /l(45'h eS 111 rin 11
d. Give a brief description of purpose,use, method
construction and daily operations of prop(
NOTE: Permit will be issued in name of landowner(s), and/or project. If more space is needed, please at
additional pages. et.p i i e- e4, /,^
project name. At t/ h-e d / ced.fi
�JC f s .^r+S 5 C w A %/ r-e

Form DCM-MP-1
m. Describe existing wastewater treatment faciliti
4. LAND AND WATER /V c w cr' v -r S h al/a y�
CHARACTERISTICS
a. Size of entire tract / 7-3n.. Describe location and type of discharges to v
of the state. (For example, surface runoff, sal
b. Size of individual lot(s) /V/ /4 wastewater, industrial/commercial effluent, '
down" and residential discharges.)
c. Approximate elevation of tract above MHW or
NWL
d. Soil type(s) and texture(s) of tract o. Describe existing drinking water supply sourc
rc 45e. Spa; / < �4-7n+y
e. Vegetation on tract /v✓ n € I h p r v ) ecr
AP.e ✓/
f. Man-made features now on tract to (4, i I') ✓;
b i d5 S. ADDITIONAL INFORMATION
g. What is the CAMA Land Use Plan land In addition to the completed application font
classification of the site? (Consult the local land sue plat.) following items must be submitted:
Conservation Transitional
X Developed Community • A copy of the deed (with state application on
Rural Other other instrument under which the applicant clain
to the affected properties. If the applicant
h. How is the tract zoned by local government? claiming to be the owner of said property,
C a rl-1 en e c i a/ / n-►rir-i < forward a copy of the deed or other instrument
which the owner claims title, plus written perry
i. Is the proposed project consistent with the applicable from the owner to carry out the project.
zoning? X Yes No
(Attach zoning compliance certificate, if applicable) • An accurate, dated work plat (including plar
and cross-sectional drawings)drawn to scale in
j. Has a professional archaeological assessment been ink on an 8 1/2" by 11" white paper. (Re
done for the tract? Yes No Coastal Resources Commission Rule 71.0203
If yes, by whom? Az'! detailed description.)
k. Is the project located in a National Registered Please note that original drawings are preferrc
Historic District or does it involve a National only high quality copies will be accepted. Bit
Register listed or eligible property? prints or other larger plats are acceptable onl;

Form DCM-MP-1
site. Include highway or secondary road (SR)
numbers, landmarks, and the like. 6. CERTIFICATION AND PERNIISSII
TO ENTER ON LAND
• A Stormwater Certification, if one is necessary.
• A list of the names and complete addresses of the I understand that any permit issued in response to
adjacent waterfront (riparian) landowners and application will allow only the development describe
signed return receipts as proof that such owners the application. The project will be subject to conditi
have received a copy of the application and plats and restrictions contained ;n the permit.
by certified mail. Such landowners must be advised
that they have 30 days in which to submit comments I certify that to the best of my knowledge, the propc
on the proposed project to the Division of Coastal activity complies with the State of North Carole
Management. Upon signing this form, the applicant approved Coastal Management Program and will
further certifies that such notice has been provided. conducted in a manner consistent with such progran
Name I certify that I am authorized to grant, and do in I
Address grant permission to representatives of state and fed
Phone review agencies to enter on the aforementioned land:
connection with evaluating information related to
Name permit application and follow-up monitoring of
Address project.
Phone
I further certify that the information provided in
Name application is truthful to the best of my knowledge.
Address
Phone
This is the day of , 19
• A list of previous state or federal permits issued for
work on the project tract. Include permit numbers, Print Name
permittee, and issuing dates.
4 is-r C, „v / 5 4 ,5 3//,f/ ?c Signature
landowner or Authorized Agent
Sly w 7cl -h - 0 % u - 0u / 7
,t-t/ !7'45 {^es Y/ 3. 4i "79
• A check for S250 made payable to the Department of Please indicate attachments pertaining to your props
Environment, Health, and Natural Resources project.
(DEHNR) to cover the costs of processing the DCM MP-2 Excavation and Fill Information
application. — DCM MP-3 Upland Development
• A signed AEC hazard notice for projects in — DCM MP-4 Structures Information
— DCM MP-5 Bridges and Culverts
oceanfront and inlet areas. — DCM MP-6 Marina Development

Pay to the / I l \,
Order of V
0 YN.Q_. ` " ` � w�� 1n Dollars
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W�BANKCAW
Shallow,NC 28459
wruw.w amawkank.com
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®Ma•Ne Amerman --- — __ __ - 3GUARDIANS SAFETY BLUE OIWBL

•
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. Agent
IIIPrint your name and address on the reverse /.-12�n ❑Addressee
so that we can return the card to you. ed b^) TTh
ame) C Dat of Delivery_
is Attach this card to the back of the mailpiece, ��t ` I
or on the front if space permits. jU J
' D. Is elivery address different from em 1. ❑Yes
1. Article Addressed to: If YES,enter delivery address below: .JJo
MC W\%Jac --
C . 3. ice Type
D-gr;l, LP(-ACertified Mail 0 Express Mail
❑Registered 0 Return Receipt for Merchandise
0 Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7004 2510 0000 7055 0246
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt to25s5-02-M-154o