42818D - Keith

CAMA/ _ DREDGE & FILL _ ,uri
GENERAL
PERMIT Previous permit#
,.New Modification .Complete Reissue Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources 1
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC —7)4• )i D0
nn Rules attached.
:nt Name K-U 55 E.cc- 4 F S-r E-t Project Location: County © S L L.----'
i
s 2`S 35F,Pz IL dA NG. b rt, Street Address/State Road/Lot#(s)
1.0 N G- S�,R-o State(s Q ZIP ;D2 (o ) 05 G N A1v✓1 G k. S)-1J/Z---S
#(11 cal (003- 657%Fax#( ) Subdivision ( Al)v✓=G IL -14 J.R E S
•izedAgent j)j vE i AVS r City3t)i ADS Fa`L(1 / ZIP``2 'j 31
d CW w >PTA ❑ES ❑rrs Phone# ( ) • River Basin V"'',,►ill:
❑OEA ❑HHF ❑IH ❑UBA I N/A
1: Adj.Wtr. Body bh.\Avv. .c.U— �4.-.1 .(Car
C PWS: ❑FC:
no PNA ye no Crit.Hab. yes / no Closest Maj.Wtr. Body_ A=V✓
of Project/Activity -1...-)Ir,NL L X 1°1 2 PT G It c.,..>/ /2 X I L, 1 H E v l) 1 2,X
>PCT 1.1F i
(Scale:
jock)length ( x 10)Z
rm(s) 11.?( 44 4 ,,
•pier(s) C.-AA``�"!)V`11 1;�
y ,__
length ' �.
lumber i(
?ad/Riprap length s ••1
ivg distance offshore •
•flax distance offshore
channel �__
•
:ubic yards
amp
DUS-et. '
Bulldozing
7
ine Len• h --)5' ` 4 `, • N,4 4-
yes no )<,
ags: not sure yes
lt Dk_
Drium: n/a yes CIO
yes 0
-Attached: yes no
Jing permit may be required by: QN-)L„, C•c r .-i \\\ . [ I See note on back regarding River Basin
,/c..e,..,i r...••A:4:...... S,n 1 I • I"Yr G✓, - .� P_ . I - - :. ,>t ._ 7Z

DIVISION OF COASTAL MANAGEMENT
ADJACENT'R ARIAN PROPERTY OWNER NOTIPICATION/W.�IVER FORM
, )
Name of Individual •.pplying For Permit: I"St-<-S/ -1 i
f & zs /jeir-11
Address of Property: 0 4A'e _ade. SAt,i'e , ONetiC _
•t or Street#, Street or Road)
Si/lead, rf,, , i 1O&)
City and County) V
I hereby certify that 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 des4rlption 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 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.
1
1 ....rWA1VE1f SECT
i
I understand that a pier, dock, mooring pilings, breakwater,boat house or boat lift must be
set bck a minimum distance of 15'from my area of riparian access-unless waived by me, (If
you wish waive the setback,you must initial the appropriate blank below,)
I do wish to waive the 15' setback requirement.
I c not wish to waive the 15' setback requirement.
o A V1.. Pk, c,i l i v f-4-c9 tc--5 L 1-
0 s-
1
l�iu. i: so ate
r„,..L . APA
Pii t Name
NCDERII

IO OF COASn1 L MANAGEMENT
, CENT RTPAR.IAN.PROYP,R TY OWNER NOT IFICATION/WI VE]Z FORM
Name of Individual t pplying For Permit: el 2
4"\-1
Address of Property: b 5 C__,V\p `cJC hp re Dr(
Lot or Street#, Street or Road)
On a6 u,ri-k- iSeacks Fe.ric
-
(City and County)
I hereby certify that own property adjacent to the above-referenced property. The individual
applying for this perm t has described to me as shown on the attached drawing the development they
are proposing. A des:ription or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal,
1
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.
InTVER SECTION--
I
1 understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
set lack 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 o wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
� _ _ 7-3 1-0
Sign Name Date
'avt 41/Je rst)v•
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Print Name
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