41512D - Henderson

(CAMP►/ DREDGE & FILL
iENERAL 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 SA NCAC ') ) . I La
,Rules attached.
t Name Jo E .1 nibk,( 5;�r✓ _ Project Location: County �►j�j(��
(y Ze t-C— ►7�t NT(� _ Street Address/State Road/Lot#(s)
eJ�a.AS Pi2n�11 State NL ZIP 2—B}t( C7 NL I �:� -L lPas�..'�t
( ) Fax#( ) Subdivision
ed Agent AN r'Lr n x (11 Af.Zu 1 — City =AIDS 'C�A_tL ZIP,Z'�31-I(,<
❑CW 1 W ?TA ❑ES ❑PTS Phone# ( ) River Basin W t iI
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body('A A(r (nat
❑ PWS: ❑FC:
yes IC) PNA yes / Crit. Hab. yes / no Closest Maj.Wtr. Body C Vt- wS L �A. 1
Project/Activity 5 f n L 5. TT,i E y 161"1-i L, (a.•J
(Scale: , .7 ZG
:k)length
(s)
er(s) -
igth
nber
I/Riprap length
distance offshore
distance offshore
annel
is yards
ip
se/ oatli /2 X f
illdozing
•
•
Length I oo t-
not sJre yes no _ •lit* t
: not sure yes B
urn: n/a yes
yes
ttached: yes E
ig permit may be required by: 0 t•-.), 'l See note on back regarding River Basin ru

ei u4 ii : 4aa p. l
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: �v I' GIaC(SU,,t
Address of Property: ' Ad/ �>, ./
(Lot or Street#, Street or Road)
1/ e6 "-(//77 12, C
(City and County)
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 they
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 Coastal
Ianagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
dthin 10 days of receipt of this notice. No response is considered-the same as no objection if
au have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
t bck a minimum distance of 15'from my area of riparian access-unless waived by me. (If
iu 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.
' -.- 3 3D -p s
n Name Date
ES J E,1//</A .5
at Name A7:574,
��

et u4 ii : gaa p. i
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO I II.ICATION/WAIVER FORM
Name of Individual Applying For Permit: -"So 1� �✓5 o
Address of Property: / t2 f�e4 7)0 G?7Le,
(Lot or Street#, Street or Road)
r
ci'f't A 6,
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individual
ippiying forthis permit has described to me as shown on the attached drawing the development they
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 Coastal
Management; 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
vithin 10 days of receipt of this notice. No response is considered the same as no objection if
ou have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
4 bck a minimum distance of 15'from my area of riparian access-unless waived by me. (If
Mu 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.
-, t\ �g 3 - 30 --06
Naie Date
cniriL-\ , VJecti-kn AVA
rit Nan

SNEADS FERRY, NC 28460 66-19/530
[phone] /Z e
PAY TO THE A
ORDER OF / 1/ . C. I�- �. /t- $ -00,
MEMO 4 /3( /2, L/,r// AUTHORIZED SIGNATURE
00046960 1:0 5 3000 L96i: 0006 50 5 2 L9900