41573D - Koerner

•CAIVIA/ ❑DREDGE & FILL .`i A
3ENERAL PERMIT Previouspermit#
(New Modification Complete 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 5A NCAC H , ) Z..0°
, r �/ El Rules attached.
t Name W Z l..t- h�Q tQ Q_ Project Location: County DNS co L.✓ _
3y j H/w i E Q vvA�/ 1>C ; v c Street Address/State Road/Lot#(s)
OEAns F�L4..y Staten ZIP L$tl6(3 3'1) V✓T,kwAi 'ThRZv t=
(�i t 3) Lin-3 %, Fax# ( ) Subdivision r I I
ed Agent m (\Q,Y_ Cr"N v ►..,'rs City�,vEa.�5 Fc�Ry ZIP I"/tc
❑cw X'TA ❑ES ❑PTS Phone# River Basin r1! i
( ) HLI
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body S►L4 PIP S I,t ewe .) QD
❑PWS: ❑FC:
a/ no PNA le / no Crit.Hab. yes / no Closest Maj.Wtr. Body As v✓
Project/Activity NS7AL L. (C X )3 w) A I k X I le I i4 E�) n C4'e a /J
Q..,�—i 4TlT (Scale: I = ?
:k)length
(s) I(o x )to
igth
nber
i/Riprap length • •
;distance offshore
x distance offshore 6i • •
cannel 1.
,ic yards
,p
s Boatlift 1 Z Y 1 L
illdozing
I
Length t Q. -- IV 1-k y✓
of su yes no \ 1 w v t _ 1i, a v_ __.��
not sure yes no Q 4 J y k 4 4 4 L
um: n/a yes '�
yes @a
,ttached: yes
ig permit may be required by: ©PS L..34.A✓ C,Ok,n,J'`1 •
See note on back regarding River Basin rt

C. Lee Barker, SCLA, CIC,I
FR TIER Raymond E. Boltin, RPA
, j USTERS. Claims Adjusting Services/Risk Management William Koerner, Mgr.
A
Reaufort/Lady's Island,SC Myrtle Beach/Conway,SC P. O. Box 4548
Brunswick GA Orangeburg/Barnwell,SC Wilmington,NC, 28406
Charleston/Mount Pleasant,SC St Simons Island,GA Phone[phone]
Florence/Darlington,SC Valdosta,GA
Georgetown/Litchfield Beach,SC Walterboro/Hampton,SC Fax [phone]
Hardeeville/Ridgeland,SC Waycross,GA Email: rboltin(a,frontieradjuster
Hilton Head/Bluffton Wilmington,NC
"A Full Multi-Line Adjusting,Appraisal and Professional Claims Service Organization"
/eo."-- v 7
S
/1/:
../ �iq~e
/
67? 0 ,.�-�- ../�-E'.� S ��--- �G'.�.c C sC
..._
,.... ‘� i2 tic 06. A'R ,.(72,,, .................. .5 .
( ,..-- .7( G"/a l 7✓ ✓ KF �� oCc '
r
2' I r (..
?C:709 •
(
/k-- 7 4
,

29-2005 14:13 From: To:94525990 P.1 1
pIVISIQN OF CQASTAL MANAGEMENT
AD]ACLNT RIPARIAN PROPERTY OWNER NOTIFICATION/WM\rEP. FORM
Name of Individual Applying For Permit: 1 "7 K—���2,✓�/?
Address of Property; - 7 ( tt./.q -4, 0.1
(Lot or Street g, Street or Road)
1\-E,4 5 N i?/2 y OA_ 5 [ 0
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shoe n on the attached drawing the development the:.
are proposing. A
description or drawing, with dimensions, should be provided with this le-ter
,/
1 ' ,_ P 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 3S405 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.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift'must he se!
hck a minimum distance of l5' from my area of riparian access - unless air ed by me. (If you
\ ish to v.give the setback, you must initial the appropriate blank below.)
�-/ P I do wish to v aive the 15' setback requirement
(yZ I do not wish to waive the 15' setback requirement,
nq 0440 pia /y,- or-
Sign Name Dote
l C /t P ,zkj I
Print Name A7:4;51r:AL

-29-2005 14:13 From: To:94525990 P.1'1
pIV[SIQN OF CQASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMA.IVER FORM
Name of Individual Applying For Permit; ' /l /
c:' Z
Address of Property; _. Y( ��� 776 ~
(Lot or Street #, Street or Road) y
Jam'f'q S /6,("/2 0 .S
(City and County)
I hereby certify that I 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 the:
are proposing. A description or drawing, with dimensions, should be provided with this !n-tet-
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.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakw ater, boat house or boat lift must he se!
hck a minimum distance of 15' from my area of riparian access - unless w aived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 1 3' setbac:: requirement.
I ddnot wish to waive the 15' setback requirement,
Ii/
Sian Ne. ' Date
c Atiely ,
Print Narde

Pay to the 1 C'1 6/1'� I $/
I Order
it1�G)4 Dollars 8 ,.,
FIRST CITIZENS 365 .h
BANK hi.rin p-0YN:amN BCkII 8 T at ccnp-y
>
4 Ai1� r
www.firstcitizens.com
For /S�3 "
I:053 L003001:00353 20 L L13030 07339
.rwrt,&'ait:aaums�x,•rr.es�ir�asti�r, .. MLmMIMDi' 6811111•11
COASTAL VIEWS.WOCV
•
•
•
•
•