38416D - Tomz

CAMA/ ❑DREDGE & FILL
3EN ERAL PERMIT 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 /��O
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
/� � 1 C [47 Rules attached)
t Name &;/II i/1 F,t- $G AA y Iv. /TD Ti Project Location: County �l v'0'� "' 6
of Z. �l }✓u t Glt�tk�? C ✓A e/� Street Address/State Road/Lot#(s)
olit/`�D✓i"i State s ZIP - •Ar 412-
( ) Fax#( ) Subdivision
ed Agent City ZIP
ii cw IT EW 7 PTA _--ES ❑PTS Phone# ( ) River Base/
❑OEA -HHF IH UBA ❑N/A
Adj.Wtr. Body ��i/JAP (nat A
PWS: ❑FC: 1/� V
,
yes / no PNA yes / no Crit.Hab. yes / no Closest OMaj.Wtr. Body / `
Project!Activity /42 f�D`� /B1 e, T''14 it G{OG
(Scale: / '
ck)length 2B1 X(. -
gee
(s) 3 x 30 T
iers ii 41itierel-her0e —7 : —: : -
I
ngth
mber � ,
d/Riprap length
i
distance offshore ! 1
ix distance offshore 1 ± _.. —,.. { _ _ l•
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t
lannel ~
I i
lit i
} _
sic yards I-
np — . . l �.:.. a
Ise/Boatlift
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ulldozing f.4_ i
v I I
di
i { f i i I a$1ef t ,
ir
e Length /z d ... _. } .{- _ --. _..+-
---� - — r — -
not sure yes Z$trt
�_
s: not sure yes
jl 4-
ium: n/a yes fI —T
attached: yes // I ��
ng permit may be required by: �v�'h 1 ef. n See note on back regarding River Basin ri
- _ _ _ __ . :14 . _.1 I I /1/_ , D_ — _6-l .t /' _ i ._f,1-44 _ -

1
GENER4T: PERMIT COMPUTER FORM
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.DDT 1O ,T N= S: •
=C DESIG: \•-7 OP=7 1_�. 01 PRO].DESC: /f - /Z
(�'ul ori� chic talc:I)
WORK it/ z/1 Y.4
�� =) 7-6 Ox31
The: • 0(V 1, 17`f
(win 5)
---------
ACTION D:PMATIOAT
•
D_RC�&:� I-REQ. l :
CaMAM=JORDEvE?REQUIRED:

DI'Y' Sj 2 oF cQAsTAL MAN_A(3ENII NT
AnIACENT.KIP,NRIAN PROPERTY OWNER tiOTIFIcATION/WAIK k FOR...M
Name of Individual Applying i°:Ir Permit: ,'ll. A th !; `. /i, c . l oo X 2-
Address of Pro re
(Lot or See 0, Street or Road)
i
(City and County)
I hereby certify that 1 own property adjacent to the above-referenced property. The individu
applying for this permit has described to me as shown on the attached drawing the development tht
are proposing. A. description or drawing, with dimensions, shouA i be provided with this letter.
____VCI have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coast
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39i
within 10 days of receipt of this notice. No response is considerr.d the same as no objection
you have been notified by Certified Mail.
== - — L__-•__ .:=�_ .... -- = _- --.___---
WAIVER SECTION
1 understand that a pier,dock,mooring pilings,breakwater,boat house or boat lift must be
bck a minimum distance of 15' from my area of riparian access- unless waived by me. (If y+
wish to wave the setback, you most initial the appropriate blank below.)
I do wish to waive the 15' setback requirement •
I do not wish to waive the 15' setback requirement.
---- ems:--. .__ .. �.� -�
S. _.. -Q___- 6:72z..3 ---r,----*C.1====221111E
ign Name ate s
_.,_:._.`t.._.n NCDFNR

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION.WAIVER FORM
Name of Individual Applying For Permit: /.AJ, //. A Al F, `f e,/nANcl .;� , o a
v Address of Property: �..p l . " u ciLm BA/ Cx_eck. J
(Lot or Street#, Street or Road)
a M opt i 6u 'SGVitk (16ani
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individi
applying for this permit has described to me as shown on the attached drawing the development th
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coasi
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objection
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
bck a minimum distance of 15' from my area of riparian access- unless waived by me. (If y
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.
f a�S- \ Name Date
f _ , r r