41457D - Price

( AMA/ DREDGE & FILL ,�'U 4
3EN ERAL PERMIT Previous permit#
LNew ]Modification ;Complete Reissue Partial Reissue Date previous permit issued
•ized by the State of North Carolina,Department of Environment and Natural Resources �� /`U U
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
Q LcR(iles attached.
:Name `h)l P , C-k / 7 Project Location: County
`V/J Rtlw\h,(a "T12 C- 1 R • Street Address/State Road/Lot#(s) /0 ,11*( 1'
C 1^ D, n:1 State NCZIP 37.) (o
(3)„215 - 477 Vy Fax#( ) Subdivision
ed Agent j IC 14 5 5 City f- N ZIP 0 k'
❑CW ❑EW ❑PTA q2S ❑PTS Phone# ( ) River Basin L.Whit
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body Oi/1.76 I p f i A-,(MA/ (nat
❑ PWS: ❑FC: A—}
yes / no /'�PNA yes no) Crit. Hab. yes / no Closest Maj.Wtr. Body /4
/r--'1 ) w
Project/Activity I_L^\\< t-\P A t) t!„Q, v l4 c lj o (L ( ►n/-e 4 I n' ( (6414,44)
Ir
/(Scale: _
:k)length
et)
er(s)
igth n r' ^`.
er , ( I—
iprap length -V /-
distance offshore
x distance offshore l -
Ca(-4
annel .i \ .b kk
W (w
lic yards '( __.-£. _.Z� . — '_"'`�,� ^4(•,A.[O'✓
'p ` �j I� f,,
se/Boatlift
illdozing
t /1
Length I • P -
not sure yes no
not sure yes
um: n/a yes lir
yes n•
ttached: yes no
ig permit may be required br:70 Gv n, 0 w NO/tjC,., -,, -4C•iL/ See note on back regarding River Basin ri.

6.ps - 50y)1
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER.. FORM
Name Of Individual Applying For Permit: �)
Address Of Property: ) c> Ain n Q ,
(Lot or Street t, Street or Road, City & 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 .
.0®
•
If You have objections to what is being Proposed. please write the
Division of Coastal Manaaement. 127 Cardinal Drive Extension,
Wilmington, North Carolina. 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response -is considered the same
as no objection if vcu have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbags must be set back 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..
� ,�e +3' I do not wish to waive the 15'setback requirement.

Locality Permit Number
GENERAL INFORMATION
LAND OWNER
Name 8 1)
Address V/%0 it/,y 7r-e- Ct,✓�
City 1 4 �D i iv U State //(- Zip .7--7 a es— Phone 33e a1s-
AUTHORIZED AGENT
Name go e giers S z9 CAS/ l-!/e-yi'e it/
Address ?98' (tit rr..s to/C 5 L r' �LL
City Xo�I!/t' State /l/C- Zip �rYg-2 Phone 9/0 T W S
LOCATION OF PROJECT Jo 7 mad;iv /?)- /,Io lc e-
(If not oceanfront,is waterbody natural or manmade?) /11. ait/M act
DESCRIPTION OF PROJECT it 7e4(l lac `i c,cL
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline
PROPOSED USE
tResidential Commerical/Industrial Other
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT-UPON SURFACES (such as driveways,etc.)within 75 feet of the estuarine shoreline,or 57
ORW shoreline,or 30 feet of the public trust shoreline.
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING
SQUARE FOOTAGE OF SITE
OTHER PERMITS MAY BE REQUIRED: Zoning,Drinking Water Well, Septic Tank
(or other sanitary waste treatment system),
The activity you are planning may require Burning,Electrical,Plumbing,Heating and
nennitc nther than the rAMA minnr Air rnnriitinnina Tncniatinn and Pnercv

': COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
Mete items 1,2,and 3.Also complete A. Signature
4 if Restricted Delivery is desired. , p �/ ❑Agent
�
your name and address on the reverse �fJ'f/-1_ / oV.l "'� ❑Addressee
it we can return the card to you. B. Received by(Printed N- e) C. Date of Delivery
1 this card to the back of the mailpiece,
the front if space permits.
D. Is delivery address different from item 1? ❑Yes
Addresspd to:
If YES,enter delivery address below: ❑ No
A)1-/i 41:),1-0-6-6-6-1
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1 1 , /112_&4\ 7 i' ! 3. SSery c Type _ c o o
/�fy./��, ����^/',� 1K't'Certified Mail ❑Express Mail •• Z m o
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0 Registered CI Return Receipt for Merchandise ° m
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0 Insured Mail ❑C.O.D. 0 lo
4. Restricted Delivery?(Extra Fee) ❑Yes O O }
iNumber 7002 3150 0004 0315 9833
fer from service label) E- O 1 D (�
1 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 - \ ;\r"-1
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COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY 1CO
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to items 1,2,and 3.Also complete A. Sig.:turee/ 81ev^,
C
Restricted Delivery is desired. ��/`""s�'L ❑AgentCur name and address on the reverse Addressee r mrue can return the card to you. B. Received by/ rinted N •- .of Delivery ` ru p
his card to the back of the mailpiece, v / ^ �s� /^`p Hit n
e front if space permits. -L ('1 r (i o x Z
D. Is deliveryaddress different .m der1? o o m
r A a GI CD
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Idressed to: O r
If YES,enter delivery add w: ❑No ��, 1 r b,1 "�v f-
tio,b1 01--1j,b_P-L(L.N R 19 2005 :� `�. .{
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4 L./JC-- 3. Service Type 2 g v ' i +"4' �- m 0
C9 certified Mail 0 Express Mail ==
aO U !I 0 Registered ❑ Return Receipt for Merchandise 1 m m
❑ Insured Mail ❑ C.O.D. *. *
4. Restricted Delivery?(Extra Fee) � L�
rY 0Yes r -.--. 1`Z Z
ember 7002 3150 0004 0315 0021 - � ' "o *
from service label) _ :
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811,August 2001 Domestic Return Receipt 102595-02-M-1540 - 'Q cn
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