41421D - Lacy

CAMA/ DREDGE & FILL NC' 4
}EN ERAL' 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 l2 007
/ � [ Rules attached.
C4a Name ,/ 4ii .,�halt" Project Location: County 't Ce'
531/ ba/c4es t-/' Street Address/State Road/Lot#(s)
7telr5 Zee& State /se ZIP 79q6si g I l .i(/!r' 121�i1
(334 ) .24/1,11934 Fax#(NSP) 515 6957 Subdivisionsi r----
BdAgent // ✓_ City !�io /inf/ 70/> ZIP Z�4//1
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w [I1' IF.6-A PES PTS Phone# ( ) River Basin C13I0
E OEA ❑HHF ❑IH E UBA N/A Adj.Wtr. Body C0,1 a4/.0 e03-/n
❑ PWS: ❑FC:
Closest Maj.Wtr. Body s4'''td'
des / � PNA /� / no Crit. Nab. yes / no /
Project/Activity `�1'+'7S�I!*C 7 h!!.a /eij'' L�� �Cj geo}
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k length
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er(s) G'X 79
igth
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distance offshore Pre' e..1-e f` /,'/?
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reached: yes 11 \�__/ _.__ 0 _. ..---.
g permit may be required by: y/t'1 c + See note on back regarding River Basin ru

RICHARD R . LACY & JANET L . CRISP - LACY
5311 DORCHESTER ROAD
GREENSBORO, NC
May 16, 2005
Robb Mairs
Fax [phone]
Thanks for the return call and your help so far. I really do appreciate your willingness to
do some of this by Fax
I am enclosing the check and the documents you need for our permit via FedEx overnight.
You can fax me at 336-294-9472. Bi"'s 7a
4 ilk o• 515 5-1 tf
Richard R. Lacy
Ari
RECEIVED
DCM WILMINGTON, NC
MAY 1 8 2005

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: jOitp / L . fir/ ._ /Z vv//7 L
Address of Property: it G'-e_ .
(Lot or Street#, Street or Road)
.
bv-Le-y,„tir ,
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individua
applying for this permit has described to me as shown on the attached drawing the development the:
ire 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
Manage..-eat, 127 Cardinal Drive Extension, Wilmington, NC 23405 or call 910-395--.DS1
vithin 10 days of receipt of this notice. No response is considered the same as no objectioL i
Tou have been notified by Certified Mail.
WAIVER SECTION
undierstarid that a pier,dock, mooring pilings, breakwater,bo?.i house or boat lift must
)elk a mih;.iti-iiiinl distance of 15' from my area of riparian access-unless waived by me. (Ifyot
vish to waive the setback,you must initial the appropriate blank below.)
vv,LwijNU --ACCM r
I do wish to waive the 15' setback requirement. OIV NC
Y I do not wish to waive the 15' setback requirement. MAY 8 2005
/7 4/6 •
r )
;ign Name Z Date
. i�i1 NC- •
a�. -p .-7r_��,

PAY TO THE _ J. 'ORDER OF — /( /1 $ �o T
i'ite
aLook for.Micro Print si.nature Ilne— gray type and Ilnework,First i -c an logo on hack.If not present.do not cash.
0
FIRST CITIZENS 062 Ch514
K!-1 I"�n First-Citizens 8enk&Trust Company•
',
BANK
Grp,naboro,N.C.27402 ' `——
FOR � _ — e —"P
1:053 L003001:0006 2664 789 20 0309 L
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A/ZUUD I0 :;T1 FAA ddli YLU41 ULNIRAL-UARULINA-AiR-CON 4t001/00,
• RICHARD R . LACY & JANET L . CRISP - LACY
5311 DORCHESTER ROAD
GREENSBORO , NC
May 23 2005
Robb Mairs Fax 910-339 3 J— 3!q
1
Thanks for your help_
Tam enclosing the signed fax copy for your records.
Richard R. Lacy

cdqou0 it:IJZ I-AX '3368552642 CENTRAL-CAROLINA-AIR-CON I?) 002/00
-2005 15:51 From: To:41905756957 P.2
r416(111/ LI GPRODGE 11$ RLL N? 4142
ENERAL PERMIT Previous porrnis#
kiew riPledifitotion n Complete Reissue I _Partial Reissue Dm previous permit'Med .._ .
eel by the Sous of North Caroline,Deportment of Environment antl Natural Resoure:oll
pastel Resources Coeeenlaelen In in area ef environmental eene.ern pursuant to ISA NCAC ? 61- . 120.0
%amt. Xt440/ hock Prole*Loostion: COW*,
,53e/ /!.-2)04‘,.t .. • Street Addref4 StarA Rood/Lot#(s).,
Prefirl-4017? , Sento Ole DP Vifor 8 Woo . ..?? 4i#,....Agesko/
WO ) P49.i'Ve Pax 0 Wan 61St 6‘7 .7 Subdivision ,,.....
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el At. . Or?' il*AlliO&AI,P „— ZIP **Z
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IONA I.1141101 I. NI CI USA I 1 14/A
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et /0 PNA 42/ no CA.Nab. yes ne . . ._
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Prolect.1 Activity Cep_ithw,e?' Ned., Ator00 441-491"esjove40},_
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8 I:161'0ft mu,be required aye 409,40 ego• - . , • . : 1 s„no on bock regarding River Basin rules.
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