41456D - Stout

'LAMA/ -DREDGE & FILL \/ N9 4
IENERAL PERMIT ....
\.
Previous permit#
flew Modification Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural ResourcesOC
/
oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC '7 f'/ •/7
es attached.
Name 6&)c c (A Project Location: County En'r'1 N S w I C K
U Cl 0 G2 ti I 0 d . E (c f- Street Address/State Road/Lot#(s) /$ / TM Pa
,p r... -?...9.A1. t( State(VC ZIP J W 6 . -- /Jo cif r- 3 Pitt I-f
(9 IU) ‘ `r-) 9ys7).., Fax# ( ) Subdivision y�
.d Agent ,j K IA-SS City /� /c�n, '. _ 7 I. _ ZIP D—el/
Cw ❑EW ❑PTA /❑PTS Phone# ( ) �River Basin L No b
OEA I HHF IT IH UBA ❑N/A Adj.Wtr. Body Ct9NA / O_II- 14,AA/1✓ (nat
PWS: ❑FC: ���, /
fes / no PNA yes B / no Grit.Hab. yes / no
Closest Maj.Wtr. Body L/
Project/Activity AnK4- 4 i)
(Scale: / =c
k)length
1s) - (.-I rvv<1 F-'t3& )
tr(s)_
igth
>
I Mirap length
distance offshore
t distance offshore ` 1
annel_ v
is yards - /�J(/ J
P - (V
,e/Boatlift
Ildozing
- V
/r '
Length S�
not sure yes no 2 i „
not sure yes te, (/, ^''ry
am: n/a yes n• ? c_ L_
yes >• E(':iAl >
ttached: yes
g permit may be required by: ! " /cLf n.i lj,-( N . 1 I See note on back regarding River Basin ru

Locality Permit Number
GENERAL INFORMATION
LAND OWNER - '
Name 6 rye/'C� C l Q�t. l
Address /D 9 Or ea Ai &cid 7'ns7—
City Ate ALA/ a r G, State A/C-- Zip ,--)-g-Kg Phone ?l0 - F'Y 2
AUTHORIZED AGENT
Name s l KM-SS 1/-I (�rX/�T►'Veiidx/
Address 9i.r r re 5). /a As d/y SE-
City A/j‘,./i State /v'- Zip )- )-? Phone ?lD` 3-y-a "3•
LOCATION OF PROJECT / J l 7 r l0,4/ "Jr He lclr,v 8eotc,,[
(If not oceanfront,is waterbody natural or manmade?) /PI A.t/1Lt a rt,P
DESCRIPTION OF PROJECT .Zc rail gei t-ea
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
,K Residential 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
permits other than the CAMA minor Air Conditioning,Insulation and Energy

11 u ui: e-ip SCOLL P.
psi 5 Y 7
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER, FORM
Name Of Individual Applying For Permit: 6-c©rp,en , l;v
r
Address Of Property: t//5 / raY p�
i6,/deti/ 8cL--` Al/C.
• (Lot or Street #, Street or Road, City & Count;
•
I hereby certify ' that I own property adjacent to the abovt
referenced Property_ The individual applying for this permit he
described to me as shown, or. the attached drawing the developmer
they are proposing. A description or drawing, with dimension;
• should be provided with this letter.
I have no objections to this proposal .
.040
•
If You have objections to what is being proposed:- please write tl-
Division of Coastal Management , 127 Cardinal Drive Extensior
Wilmir:aton , North Carolina 25405 or call 910 395-3900 within 1
days of receipt of this notice. No resoonse is considered the sam
as no objection if ycu have seen- notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boa
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 wisl
to waive .the setback, you must initial
below. ) the appropriate blan]
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15 'setback requirement.
fl
/7 1 I /// ' / /

lilt R-GIO LCJClJ iV• L .
1J...J J.J .Jt,1 ✓✓VCJ
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION WAIVER- FORM
Name Of Individual Applying For Permit: eo s'
Address Of Property: ff1 l rPoA/ -
AirLeA/ G1t4 c-d ,VG rvnj
54
(Lot or Street I, Street or Road, City & Count)
•
I hereby certify ' that I own property adjacent to the abovE
referenced property. The individual applying for this permit ha
described to me as shown on the attached drawing the developmer
they are proposing. A description or drawing, with dimensions
should be provided with this letter.
-7740
have no objections to this proposal.
If you have objections to what is being pr000sed,• please write th
• pivisio o Coastal Man ement 127 Cardin 1 rive Extension
Wilmington North Carolina. 28405 or call 910 395-3900 witbin 1
days of receipt of this notice. No re!, nse s, cons,idered the sam
as no b ec
ojtion if You have been notified b �iCertified 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 wisp
to waive the setback, you must initial the a
below. ) ppropriate blan3+
•
- 1 do wish to waive the 15'setback requirement.
•
___IL. I do not wish to waive the 15Tsetback requirement.
open cl sc>aSSn'ol I1e•eci4
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