42054D - Long

rCAMA 7 J DREDGE & FILL ye 1.V Ca 4
a,ENERAL PERMIT Previous permit#
!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 21/./706
L pN q, RA/0 [q,Rdfesattached.
t Name GolliiPf I •Ae n: K (v Project Location: County /Ve ,/7 / 4tv0Ver2
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/n • �Jl( 10-3 0 Street Address/State Road/Lot#(s) /,)() .5".44
1/4/A/(z-71A., State A/C ZIP >0`( ! f ma77S C>:lAvitei <
(9(0 ) G a yf 3 I Fax#( ) Subdivision
ed Agent 6/fGCs , 1 1 ( ' City h1 RiWrl /I It`' a A l( ZIP .a si
❑CW p,E'Vfi ll&PtA -ES __ PTS Phone# ( ) River Basin (i4t
❑OEA ❑HHF ❑IH ❑UBA N/A Adj.Wtr. Body /2/O7`/S C WF
na /r
❑ PWS: ❑FC:
yes / no PNA yes / Crit. Hab. yes / no Closest Maj.Wtr. Body
Project/Activity 7F i4qc.fi*Y NAq 7`'rv(r 6 OC
(Scale: / -
:k)length
i(s) C�) v /tl‘ / 70771
igth
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1/Riprap length
distance offshore r�` 77 I
x distance offshore m 0. f >A a I.
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s: not sure yes C'
ium: n/a yes ,�
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lttached: 6ye� no
�g permit may be required by:-hh r,v 0 F IA/of;6 t511, . See note on back regarding River Basin n

JUL.13.e17b5 1b 4cRf1 Nt;ULNK WINO NU.4J0 r.1
State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
Michael F. Easley, Governor William G. Ross Jr., Secretary
FAX COVER SHEET
Date: �/3 No. Of Pages:�e eluding cover) 2
To: 6'tL4/ ''r7 From: IQO / r'rs
CO: CO: NC DENR
FAX#: 347 / FAX#: 910-B=004 34g•6 '4/
REMARKS: giv"r, W 3 l /*ref
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127 Cerdinnl Drive Extension,Wilmington,N.C.28405.3845 Telephone[phone] Fax[phone]
An Equel Opportunity Aillrmotive Action Employer
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JUL.1d eueiD 1b•4CHr1 r1LIJLIYK 141KU 11V.'4JLJ r.c
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: / r l Y T`n 6-UJ/C,
Address of Property:
(Lot or Street#, Street or Road)
(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 they
are proposing. A description 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.
WAIVER SECTION •
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 to waive the setback,you must initial the appropriate blank below.)
`V./ ' `� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
66klikk EC) kQLb\—\ -7/ts/0 s .
Sign Name Date
Lai.W61. E . C'-h t 11-en—) .. • rircirA
Print Name •
, I/ -, /11111wM•\ew

JUL.1d.dUld 1E ;'4H'1 NLULNV WINO IYU.4d1 F'. 1/1
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY •WNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: IX a v -/-7Y\ �/
Address of Property:
(Lot or Street#, Street or Road)
(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 they
are proposing, A description 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.
WAIVER SECTION
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 to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
si4k I do not wish to waive the 15' setback requirement.
Name ate
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t Name � ATA
as7o ) /)C) ►iAPRwr•►■w

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910-686-4131
DATE /_ __._t f J
PAY
TO
ORDHE OF LE, $ /DC/
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CEN RAL CAROLINA BANK
AND TRUST COMPANY
WILMINGTON,NC 28405
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