40419D - Kelly

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CAMA/X DREDGE & FILL s A.
IENERAL PERMIT Previous permit#
New 'Modification _iComplete Reissue Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources si 1.-0 op
pasta)Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 N. >R„les attached.
Name g o 3,-( 14-E 41.-' Project Location: County D N S L o v-)
i Vi5) `S LJi, Street Address/State Road/Lot#(s)
LP' G=T y
State VC. ZIP ` c'S 1 14S S7
Eta)31-7.34/4S Fax#( ) Subdivision
:d Agent Sf T.V F A1sC'Y 39-5 city sU.4 LZTk-, ZIP Z&t1 4 '
❑CW AEW ETA _XES ❑PTS Phone# f %3 ) 3Z-1-3,-11 S" River Basin
ElOEA ❑HHF !❑IH ❑UBA ❑N/A Adj.Wtr. Body L'__PLb)A L (nat
❑ PWS: ❑FC:
yes G PNA yes / no Grit.Hab. yes / no
Closest Maj.Wtr. Body ZW
Project/Activity Q.E Q A lL ►=Y 1S-II N LT 1) 4-1(.— i i tJ S-ip L.L L‘14.-\0 4--0.1 t
T l-LFY i ti\ovE %‘•AA.Ni...‘\E PON Z.2 vA'rG CLAW Oha_b (Scale: 1Isjlo
:k)length - — i i
C
ier(s)
ngth + P• _ _ -
mber
d/Riprap length LI f
;distance offshore 7 ?Jew {
ix distance offshore L �
O.
•
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cannel nf i.....
trI
u .,,, fXTTIT)i 'G b0 .K
bic yards / 1 i I .�...
v J r3 gE • £�.19fla.4jn
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np r1
Ise/ trilhe t ` , 1 I l_.
IZX IZ �"
lulldozingG/L W L{�
f4`l
& r>r; , Tr,-(-
ie Length c:< �. v Or U i /4&i !, 1)f14-r• 40,0
not sure yes L.
ll
;s: not sure yes ©o frif71 1 L
rium: n/a yes a V M ! P L
yes
Attached: tf. no
ling permit may be required by: 5 l.t Q F GZT`'I . I See note on back regarding River Basin

SNEADS FERRY, NC 28460 66-19/530 Zi y
[phone] �
PAY TO THE // ��
ORDER OF /P-( /1' •A . 6 i Cam-A/• /Q i $ 7 0 Q
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_ 9.D�Lv �0"/� 22'��, J y Jy( AUTHORIZED SI TURE
00045720 I:0 5 3000 19 6i: 0006505219900

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ACTION R O

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO 111.ICATION/WAIVER FORM
ne of Individual Applying For Permit: / j) b4,fr' M:i//;/
cress of Property: 7( 7 /S s/
(Lot or Street#, Street or Road)
(City and County)
;reby certify that I own property adjacent to the above-referenced property. The individual
lying for this permit has described to me as shown on the attached drawing the development they
proposing. A description or drawing,with dimensions, should be provided with this letter.
I have no objections to this proposal.
rou have objections to what is being proposed, please write the Division of Coastal
nagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
hin 10 days of receipt of this notice. No response is considered the same as no objection if
have been notified by Certified Mail.
WAIVER SECTION
iderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
bck a minimum distance of 15' from my area of riparian access-unless waived by me. of
wish to waive the setback, you must initial the appropriate blank below.)
.0-7" I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
J // a/6
a Name / Date
AMA

SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
4 if Restrictedm dery is desired. X / I ���i II I��/) �/❑Agent
item• Print your name and address on the reverse Yv Ut(,A ❑Addressee
so that we can return the card to you.• Attach this card to the back of the mailpiece, B. Recei '"11 if IN 1 - C. Date of Delivery
or on the front if space permits. //3 5-
1. Article Addressed to: D. deliv address differ; from it: 1? ❑Yes
if YES,enter delivery addre belo : ❑N
ANrhoNy Mov5-€r ;1AN 13 1 , ,
/02 Powh41 i Qu5
`
cj Y 7
i A/,C, 3. '•rvice T -
Z /l 2 &I •• ifj9dA 0 Express Mail
El Regis ' .•1ajJ Z' 0 Return Receipt for Merchandise
❑Insured Mail ❑ C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number
(Transfer from service label) 7004 1350 0002 2100 9176
PS Form 3811,August 2001 Domestic Return Receipt 2ACPRl-03-Z-0985
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Si. /
item 4 if Restricted Delivery is desired. �R nt
■ Print your name and address on the reverse X; , 4 Lr I • ee
so that we can return the card to you. B. Re eived by(• i, C. Date of Delivery ,
■ Attach this card to the back of the mailpiece, 2 A' - `- fs
or on the front if space permits.
D. Is.elivery add ess differe t from item 1? ❑ Yes
1. Article Addressed to: if YES,enter delivery address below: 0140
SMN/4y f /5611641aL TAttit5
5t/`3L 5_ Nc /5°
d, rI l,a-a , Al.` . 3. Service Type
2 ti9/_G Certified Mail ID Express Mail
77 (/ ❑ Registered 0 Return Receipt for Merchandise
❑Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑ Yes
2. Article Number 7002 2030 0003 0781 8980
(Transfer from service label)
PS Form 3811,August 2001 Domestic Return Receipt 2ACPRl-03-Z-0985