39886D - Roberts

CAMA/XI DREDGE & FILL
1/ . -
3ENERAL PERMIT Previous permit#
AANew Modification _-Complete Reissue iiPartial Reissue Date previous permit issued
irized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 4 .11 00 t -1 14. 1 Z
Mules attached.
it Name isLQ vos y R...o i!E LT5 Project Location: County OS La✓
(p�(oS (, " S I Street Address/State Road/Lot#(s)
AQF GZry State 1✓6 ZIP Le we 6oto3 bl" ‘D )
(91O)327-3c1-1S' Fax#( ) Subdivision 0 it)
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ted Agent STL-v G (a u I.z )o LT City 0.f C(1rT'i ZIP Z L/
cw ':3'EW XPTA y4S ❑PTS Phone# (`f 1." )3 z7- 3 LI.1 c River BasinV✓H ZT r
OEA HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body IJ A L (nat
PWS: ❑FC:
yes /+.,no,) PNA yes Crit.Hab. yes / no Closest Maj.Wtr. Body v V
f Project/Activity Q,.G rn o t= FJ•D PAT IZ rt.\0 . PA o v c 6to L lc 1-4 E A 11 vY A T C a. ,n.n
1 (I) Z •S 'x Imo' f~L�(rc (L PZt� , 0 Z,s'x 24� ► c, 0 PLak (Scale: /-
)ck)length (nr)ya' Ai) o' x 42.!. -4.46-e-lielPTPo9Lrh ( ov ,.. WATGSL 2 ' on
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ax distance offshore Zi _
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not sure yeses
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gs: not sure yes a�o 1r10-,
mum: n/a yes Q ( `-` ( ,1 haQ v L
yes Al)
Attached: es no
ling permit may be required by: SU RP Gr r , . See note on back regarding River Basin

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: lJ�r 12-oLr �Z
Address of Property: 606 6 E- 5t--
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced__property. The indivic
applying for this pe it has described to me as shown on the attached drawing the development t
are proposing. A escription or drawing, with dimensions, should be provided with this letter
A I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift musi
set bck a minimum distance of 15' from my area of riparian access - unless waived by me.
you wi h to waive the setback, you must initial the appropriate blank below.)
t I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
# )( A 7.3D(oit
Sign ame Date
l' _, AMA wA

4 DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: 3_e f [20 '
Address of Property: .t9C9 3
(Lot or Street #, Street or Road)
(`' ' / A% C S (64/54,7;
(City and County)
I hereby certify that I own property adjacent to the above-referenced.property. The indivic
applying for this permit has described to me as shown on the attached drawing the development t
are proposing. A description or drawing, with dimensions, should be provided with this letter
• 7 ! ..) I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3'
within 10 days of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift musi
set bck a minimum distance of 15' from my area of riparian access - unless waived by me.
you wis 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.
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Sian Nana-r4e7 Date
AMA

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PAY TO THE C A/�/, A, f �. � , �oo.
ORDER OF '/
S(V 1`l ILE/) /� o GL S vi ��<
MEMO �� AUTHORIZED SI ATURE
000115720 1:0 5 3000 196i: 0006505219900