40417D - Jacobs

CAMA/ J DREDGE & FILL / ,; L
;ENERAL PERMIT Previous permit#_
KNew -Modification Complete Reissue _Partial Reis a Date previous permit issued
•ized by the State of North Carolina, Department of Environment and at I Resources
:oastal Resources Commission in an area of environmental concern pu s nt to I 5A NCAC • 12�
[Rules attached.
t Name Sgs.i.S Project Location: County Q6 N V ►2
i I y 4 k u E iL 5o i g 1 v Street Address/State Road/Lot#(s)
r'A4\ State!.) L ZIP 114 9 ►J . A w.»)E Q IJJ v D
(c% ‘J) LLZ•- 5'3 I`) Fax#( ) Subdivision
ed Agent YA A(LAC. Ewe N 1-5 -- City 1 P S AIL. ZIP 28 4 Li
�j Cw ylyW TA —I ES ❑PTS Phone# ) )2(02- 5-3 1 9 River Basin CAP
❑OEA ❑HHF ❑IH ❑UBA ❑N/A 1��✓�L
Adj.Wtr. Body SAQ 1L5 A /r
❑PWS: ❑FC:
VNi
yes / n� PNA no Crit.Hab. yes / no Closest Maj.Wtr. Body Pa W
Project/Activity Tv.)sTA L L Pr X 13 i 14,.0AT L,Z C'rs
(Scale: 1 ir=
:k)length L(' 1=1444 3 D� � —1ti , y
J"t
(s)
er(s) • •--• •
igth
nber • • • •
i/Riprap length
distance offshore
x distance offshore ' A NA-S
cannel - - ei.kis, IJ L
I 00
)ic yards
ip
'$r thIL
�Ildozing tt3MI .r i friVd
Nra 5 c�<
P , f' V
Length (DOI
not sure yes no
;: not sure yes ® uJ
cum: n/a yes E
yeSJitached: yes ® �..._^
ig permit may be required by: 1 0 P L E A L f-t • See note on back regarding River Basin ri

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
a�LP.c,I JdtCc b5
Name of Individual Applying For Permit: 1` '4 N), Ankle L)P 1 L CZCtr X)6.
c1(o- '0K -
Address of Property: ?61-0ere CD.
(Lot or Street#, Street or Road)
(Cit i and County)
I hereby certify that I own property adjacent to the.above-referenced_property. The indiv:
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing,with dimensions, should be provided with this left(
I.have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-
within 10 days of receipt of this notice. No response is considered the same as no object
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu
set bck a minimum distance of 15' from my area of riparian access-unless waived by m
you wish to waive the setback,you must initial the.appropriate blank below.)
,.w,,, I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
•
3 Feb vss—
Sign Name Date
a,n , i.P1crt1JF ArF'I e

, ,- , DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: Bc Let l NsaCo i5
Address of Property: ) (44 1. Gera ti OLocl. J o
(Lot or Street#, Street or Road)
(Cit}i and County)
I hereby certify that I own property adjacent to the above-referenced.property. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or drawing,with dimensions, should be provided with this left(
1Z I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mu
set bck a minimum distance of 15'from my area of riparian access-unless waived by m
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.
r -ti __....__ Date
RED V COOPER j

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