40486D - Tillman

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CAM IN
A/ DREDGE & FILL '. 4
:ENERAL PERMIT Previous permit#
New Modification iComplete Reissue Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources (1 __i
oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC , z e
❑Rules attached.
Name ,6d‘ T'// „ ( "4,t...) Project Location: County /f/e'e-y / i1QL
/7? ‘f , .2t' . Street Address/State Road/Lot#(s)
''i, ,S,,,,li Retae4 State # ZIP 2S//86 -75 ��4 leT .D".
(*) Fax 9139 Fax#( ) "�.---"' Subdivision
:d Agent $ Ifr e' Is41 City v(/,�,/*0%/e _g ,c4 ZIP
[I "CW L#W MITA *PO PTS Phone# ( ) ...51 f/ River Basin (G/i..*
OEA ❑HHF C IH ❑UBA ❑N/A Adj.Wtr. Body S G te 7' (nat M
PWS: ❑FC: /� //e.
/es /(o PNA yes /® Crit. Hab. yes / Closest Maj.Wtr. Body— CJ/"l��rl�/
�h �Mv
/r*ct/Activity 77 ` 1
/s1+--�'�T rt,7 ir" ,,4.-' (Scale: /i/
:k)length G 22 ' P/e'- T Li f'./.-'/ �'4.i� 40- ." 6nr>1 f/S
co /G 'X/G / .er(s) O117'
Lee $
igth
r /' T
nber
V Ripraplength
distance offshore 1.---.0*
(distance offshore
annel p e-'pcsefe �i
/2/1?/t%/',,'/ 7
is yards r
/ ile `!o�'"/1
/
ce/,,ZfT�ip 2 ./.1 X/3 ..--r
illdozing
7)/eati
6'k 2 Ypegof Z
Length
o / /fir--7 -
notsure yes
not sure yes I A ��
urn: n/a yes 1 I C/ /
ti I r S J i e r i / l l
yes
ttached: yes g f t 1/'///ft.CI F? y (p 4
ig permit may be required by: 4/ /.0,e7e . . See note on back regarding River Basin ru

33/21/20E15 08:45 • 2523378426 CCN TR IMAGING SYS PAGE 01,
03/13+'2C 5 06:48 91e7303689 STEPHEN CONWAY PACE ©1
• J
DIVISION OF(QASTAL MANAGEMENT
A.UJAC, f ' R.IPARIAii f'_ROPERTr'OWNER NOTIFICATION VP,FORM
Name of Indivtidual Applying For Permit:
Address of Property. re() - Q"- _ Y
(Lot or Street 4, Street or Road)
i
(City and ounty
hereby certiev:that I own property adjacent to the above-referenced propery. The individual
applying for th"sipermit his described to me as shown on the attacfied drawing iie deveioprn.ent they
are p:oposutg. A description or drawing, with dim.ensicns, should be provideld with this letter,
1lr' I have no objections to this proposal li
�-��
If you have objectifies to what is being proposed, please write the Llivision of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 oz1 call 910-395-3900
within 10 days of receipt of this notice. NO response is considered the sartle 2s no objection if
you have been notified by Certified Mail,
WAIVER SECTION
I understand that a pier,dock, mooring, pilings, breakwater,boat house or boat lift Must be set
hck a minimum distance of 15' from my area of riparian access -unless waived by me. (If you
wish to waive kite setback, you must initial the appropriate Wank below.)Fj
. do wish to waive the 13" setback requirement.
f
Y Cc r:ot wish to waive the 15'setback regJi:emert. I
Si" N Date
4iltt (A). C4C(414" .
Print Name ` pA

03/21/2005 08:45, 2529378426 CONSTR IMAGING SYS PAGE 02/E
' 03/18/2005 00:48 9107903689 STEPHEN CONWAY PAGE 02
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.•LAF..23. '2.,.,. _ 24 331 a2:. ?�'' "OD L-EALE2 LIEPT. :07Pe P. 002/003
@3/22/2035 19:58 9107903689 STEPhEN CONWAY PACE 01
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R �°► p1.4C�VyNE�- �NO ;AI�F,j�ATIONAY ; R 0�
Name of Indivii1ual Applying For Permit: &tL 7,.,
•
Address of Pr4c4,____4,_
erty: �'� ,_pet&
I ; (Lot or Street ii, Street r Road)
' th Ilb I _
(City and d ,flty) / �-
I hereby certi>3y that I own pro •. adjace' t to the above-referenced prop -, The individual
applying for th s;permit has descr , d to me s shown on the attached drawing e development they'
are proposing. A d cription or do wing, s th dimensions, should be provid with this letter.
4. I I haVeY,io objections to this proposal.
1
If you have dbjjectioos to whit is being! proposed, please write the vision of Coastal
Management,1127 Cardinal Drive Extealion, Wilmington, NC 2840f o call 910-395-3900
within 10 date cif receipt of this notice. Nd response is considered the sa us no objection if
you have beeul notified by Certified Math `
ti ' WAJK SECTION
I understand t at a pier,dock, mooring pll ags, breakwater, boat house or oat lift must be set
bck a winiruu distance of 15' f4sni my ar a of riparian access-unless wa ed by me. (If you
wish to waive he setback,you indst initia the appropriate blank below.)
'I do wish to live the 15' setback requirement.
I no;.wisliisl,tiwaive tie 15'setback requirement.
/44,e,rig te :4 . , ,,,'3/94/q5--
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Sign Name ; Date
1 11 s Coo-N9q/ci r . (�,(u,\ Ord,v e. ' • A
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Print Name iL ,,,,
,._.— it-2 Z/ _r) i n... 4 fi (ZQ I r��

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