40427D - Tegeler

CAMA/ DREDGE & FILL ' /' N9 4
I E N E RAL PERMIT v Previous permit#
New _ Modification Complete Reissue Partial Reissue Date previous permit issued
ized 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 44 ,
Rules attached.
Name ORD A r.l Cr tr L.2 a- Project Location: County OfVS L.�v✓
-fry
�G Ole I �d Street Address/State Road/Lot#(s)
(t-F L r•.j State Nit. ZIP LB Li C to Lvi Loth
J) 3 - 3`1?S' Fax#( ) Subdivision
Agent S ✓F Aiv2`roLT' CitySufiR LST- ZIP H9,
❑CV/ ' EW >PTA ES ❑PTS Phone# ( ) River Basin aitfIE
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS: ❑FC: Adj.Wtr. Body IJ A L- (na,,/p
Closest Maj.Wtr. Body 31ti M P
res Ka) PNA yes / ,. Crit.Hab. yes / no
Project/Activity Ile-r"Jv` X $1 S.a-`'t S T A L-
L1 F`r +J Z. f;N o-151-," ? S E (LS (Scale: f`s 2
k)length
,$)
.r(s) ol i. X LA
gth
fiber
I Riprap length 01NI4 L
distance offshore II ��
distance offshore
mnel
is yards
Bo yI �� t� Z +
• • _
Ildozing
�✓
Length
Canot `
c.l
not sure yes
not sure yes ® P 1-57. L
im: n/a yes ©o
ion r
yes ® /?/4 rh P
cached: yes ©
g permit may be required by: SO I2S r!z'� See note on back regarding River Basin ru

o y
GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: &o,2b- i ' 1 GG-E LE rL
ADDITIONAL NAMES: 5i N/� ANit'i..)o R r
AEC DESIG: £W, PTA DEVELOP AREA:_0.o PROJ DESC: P -
(Will only take 6) (Will only take 1)
fiery i
WORK: f' p L' SC_ ) 3 l 3
(Will only take 4)
c P Z4( Zy
MAINT:
(Will only take 4)
IMP: D %AI ZS3
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED:
CAMA MAJOR DEVEL REQUIRED:

•( 9/
1 � -
1)173 a 10
(Iwa?) , 3nor13b
tivvbi
`os3C1) �1-
4j�ils,�c
)1731 yniI141 X
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: P 5 LI-er
Address of Property: (%b & ( 6
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced_.property. The individ
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
✓ l��Ll� 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 must
set bck a minimum distance of 15' from my area of riparian access - unless waived by me.
you wish to waive the setback, you must initial the appropriate blank below.)
<6.r. I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
/z
Sign N e Date
♦rn A

. . . . .
': COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
Mete items 1,2,and 3.Also complete A. Signature
i if Restricted Delivery is desired.
tour name and address on the reverse X 0A44/tal;
it we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
1 this card to the back of the mailpiece,
the front if space permits. ,'
.
o 'a
D. Is delivery address different from Item i? a Yes x >
Addressed to: 0 -<
If YES,enter delivery address belo • El No
xi 0
:y (,• 6/4-VEIZ, l'i I , I 0 il
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ISO X ii 2g
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2- t-1&CI' 3. Service Type N t _
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-N.
.Certified Mail 0 Express Mail -'k•c,
0 Registered El Return Receipt for Merchandise
0 Insured Mail 0 C.O.D.
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4. Restricted Delivery?(Extra Fee) El Yes
o,
Number
u.)
?r from service label)
7004 1350 0001 1023 1060
ry 381 1,February 2004 Domestic Return Receipt 102595-02-M-1540 Cu-
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