43236D - Mellott

`CAMA / 'A"DREDGE & FILL
3ENERAL PERMIT Previous permit#
New Modification 1Complete Reissue E Partial Reissue Date previous permit issued
rized 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 ///, /1/ a
If:IR-des attached.
t Name J ,in ' "/ .P I/G7171- Project Location: County 8i N. .c e ,'d C
,517274 "7G,✓/'i(`4/44 Li✓, lam'Street, / Address/State Road/Lot#(s)lj/Q
n 1 S) o 1 State1iV ZIP y`SG� e'a
'( 5 79, ryy S FZi Fax#( ) Subdivision
edAgent J €L kLeij City h )/d1,.., Q09cA ZIP1)7yde
die!! ❑EW ❑PTS Phone# ( ) River Basin L lem 4
❑OEA ❑HHF ❑IH 1 UBA N/A
Adj.Wtr. Body r7/ 4✓Ai
❑PWS: ❑FC: �
yes PNA Q/ no Crit.Hab. yes / no Closest Maj.Wtr. Body ,4 / Wk/
no
Project/Activity Rey/.$c r X/J�,� )Gi L AA r"G/ l - SA c _coo
(Scale:/ //
ck)length
i(s)
ier(s)
ngth 1
Tuber
Riprap length
92
distance offshore
x distance offshore
cannel
•,,w h
)ic yards \ )k �! / ;t (d� (� i
j J
�p
.411
�_._-_
se/Boatlift j - — - - �._ . UA
JIldozing G !;
B Length ?Q . j
not sure yes no _.!
s: not sure yes
ium: n/a yes e,
yes 1] /U C c,:?h� 31 vd.. G✓
atached: yes 19
ig permit may be required by: y‘-/,e/0," 'PA( 4 See note on back regarding River Basin n

lifi 4/Zilt15 15:41 919859525E TONY ROGERS INVESCO PAGE @1
tJQRT.4WEST 1riT' S;a S. .7 Pelaiti ....-•.•a �W....,,.... ---
AD,]i (ENT RIPARIAN F'.R(Qr1I:.FY-OWNLR NOT IF'C AT(Q'4' A1Vh;!t FORM
Nuoz of.ludivtdua; Applying For P::rini': _.� l Y e ,! O 'i -
Andress of?mper't;: _ .3 I aC_Pa Y1 aJ t t/ er
(Lai ur Street 1+.Street or Ilo:.rit
-IAclder, 13eccc I i3r'ctna ck
(City and Con;-,1y)
1 to shy certify that I owt:prop. Tv adjactni tc air ata►vc-refs-iti•'x:c'd ptopeny. The
individual applying for'Ali pertly,has described!a me as shown on the attached drawing
t c ci veloprnerr they arc p:•c•posmng A description of dr wing.with dimensions,should
be p.rot idea with this late:.✓ �� 1 have no ohiec•tons to this proposal. ? [-
Re1, a ,�I4
ikbei
if you have objections to watt is being proposed. please Jim Gregsoe with the
Division of Coastal Management, 127 Cardinal Drive Extension,Wiliniactoa,NC
28305 or call 910-796-7215 within 10 days of the receipt of this notice.No response is
coiddered for same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
1 understand that a pier.sock,moorings pilings,breakwater, boat bons.or boat DR
mast be.set bark a miulatum distance of IS'from my area of riparian access•unless
waived by me.ilf rots wish to wane the setback.y'ou mast Initial the appropriate
bleak below.).
I do wish to waive the 15 setback requirement
l do not wish to w31.'e the 1 S' setback tequirement.
u o S—
S I F'tI N an►, Lea'
ANANN.. ,.0
:tz:1 IS k _
/Print
gig - gb — 31_
1'r;ephonc Number with Aru.Ccdr
S'warkai�lt: ls'.rpr ianp;upc iy irrr'

•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FO1
Name of Individual Applying For Permit: J + tiYl / JM
f £ a
Address of Property: 13 I 0 0 cect h 1 Va . �e s
(Lot or Street #, Street or Road)
runSw I cic
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The i,
applying for this permit has described to me as shown on the attached drawing the develop]
are proposing. A description or drawing, with dimensions, should be provided with this
I have no objections to this proposal. R ee`a.ce b u
If you have objections to what is being proposed, please write the Division of
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910
within 10 days of receipt of this notice. No response is considered the same as no ob
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift in
bck a minimum distance of 15'from my area of riparian access-unless waived by m+
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.

WESTERN MONEY INTEGRATED PAYMENT SYSTEMS,INC..ISSUER
UNION I I ORDER Greenwood Village,Colorado
08-417372000
AGENT 323436 DATE 113005 I ("Iof° r' V az-aaio2i
TIME 1043 12 4 ui 1 1 1:
084173720003 LOCATION 002546-=-e` ****
I* FAX EXACTLY ONE HUNDRED DOLLARS AND NO CENTS A•fi. TTr.P.rf•k^n.
PAY EXACTLY
PAY TO THE � // J /eORRDER OF• pip9 $R/ACCT.#
/9r egress ARA"g ;slr"R 57,'',1,"v" o e —�—
w (�PJ3 2-3(, (, five s �a / En=e��ao� A
ca•sea ev swwue rou"encc m t�hnrs off me acvexsc sac
Western Union Money Order and Design N e serve mark of Western Union Holdings.Inc/Payable et Wells Fargo Bank nd Junction•Downtown.NW.Grand Junction.Colorado
LO 2 LOO L001: 1,0081, L 7 3 7 200030