43373D - Ross

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:CAMA / -1 DREDGE & FILL
3ENERAL PERMIT Previous permit# L,iaso_D
New .'..Modification >4Complete Reissue Partial Reissue Date previous permit issued 141 la,
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 7 N - 12 7›
...Rules attached.
t Name y...' is S S Project Location: County I--.. L.✓
1 Ir.] Vg t, rY\ L Street Address/State Road/Lot#(s)_
nJ e A D S PE a-L1 State 0 L ZIP 2 6t4 6o 1 \-) Vz ►-M fl LN
( ) . °1- (o SJ'p Fax#( -) Subdivision 6 ra A N 1 vv/�\.)
ed Agent City 5...7 a AAS C.►4 4-1.1 ZIP ]..S H
❑CW LXW IOTA LT,ES ❑PTS Phone# ( ) River Basin 1/f...,Sr r
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body E v Cc ei.CT--t ( (Lts C N4.,
❑ PWS: ❑FC: E.
yes /® PNA �s ( no Crit.Hab. yes / no Closest Maj.Wtr. Body 0t `� ��'Z-V A....._
'Project/Activity 'rJ.J5C\.1- L. \ L y L1 ' 's.. LL ,� I lox '" -1---- ,"\\C-:-y
o
iE_ cZ,. L• (Scale:
ck)length L4 X 1 Z J r
ier(s)
ngth Q
. ��mber It
d/Riprap length )
distance offshore _ r
x distance offshore I ! `-'
cannel i \lam
i \ r.1"
sic yards i t
t.
se :oats -) ) I I.
ulldozing t i L.
\ , L - '
4 • I
�' �
e Length ) IO �
�Cf yes no es: not sure yes no , I
ium: n/a yes <tar> !
yes 420
kttached: yes ea)
ng permit may be required by: c.._)Y -,. U e.,..l L. ", . J See note on back regarding River Basin r

DIVISION SR CDASTAugistaggjaa
• _ • 11
:.• ;_ ��r ;r�' E.t. ��. �: s 43� � • ttF"..; . • ark r_• i . : AM,/
Fame of Individual Applying For Permit ,r4 togs
address of Property: /7 Van4 L,4 vE
(Lot or Street#,Street or Road)
�,vE,4DS F 71ey 1 A'� ONE Lo RJ
(City d County)
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
arc proposing. A description or drawing,with dimensions,should be provided with this letter,
' /, - 1 have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
5
Management, 127 Cardinal Drive Extension, Wilmington,dC considered C g405 or the same aslnolobjectionl if
within 10 days of receipt of this notice. No response
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier,dock, mooring pilings,fbreai�'n access-ater,boat omhouse
less waived by me must
(tryou
bck a minimum distance of 1S'from my area a r
P ate blank below.)
wish to waive the setback,you must initial the appropriate
I do wish to waive the 15' setback requirement,
1 do not wish to waive the 15' setback requirement,
Sign Name Dade
;6€;A ►?.�}Z 2 f}lzil-A)c? ����Z .91,AL i
Print Name
'�;�M....: w

I-2005 18:14 FROM: TO:19104875375 P.1
p y1s ON OP C A5 MAN C
r O
; � E �✓ doss Applying For Permit: fl I6/4Q- �`• ross y
me of pP�
(dress of Property: /? /4-1-ititt L.f4N("
(Lot or Street#, Street or Road)
S�E4Ps / - y, __ --- -vsLa�,✓
(City and County)
adjacent to the above-referenced property. The individual
hereby certify that I own property j'plying for this permit has described to me as shown on the thethey ohed drawing
•e proposing, A description or drawing,with dimensions, should be provided with this letter.
4.....„ I have no objections to this proposal.
r you have objections to what is being proP°5°d+ please write the Division of Coastal
Ianagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-7215
vithln 10 days of receipt of this notice. No response is considered the same as no objection if
,ou have been notified by Certified Mail.
WAIVER SECTION
C understand that a pier,dock,mooring pilings,breakwater,boathouse se orw boat
o t lift by me.st he(�Y�
bck a minimum distance of 15' from my area of access
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,
t� . - _
- tJauO
S Name Date
Print Name AVA

•
•
LTC MICHAEL A. ROSS, USA (RET) 2057
KYE W. ROSS
2118 ANCON DR. PH.910487-5375 �� �t 66_112/531
FAYETTEVILLE, NC 28304-0403 Oat? _ U 83513
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T O ADV®TAGS
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BRANCH BANKING AND TRUST COMPANY
• FAYETTEVILLE,NORTH CAROUNA
AP
I:053LOLL2Li: 5LL ? L78996002 57