40459D - Vanderan

'CAMA / DREDGE & FILL 4
1ENERAL PERMIT Previous permit#
!New _Modification -Complete Reissue Partial Reissue Date previous permit issued
lzed 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 7//. MO
L'7Ftules attached.
t Name LID Gk i V/& dot 4, n Project Location: County /rt It Q,r
17 Id let t)j(d 4 i f 2 10 j. Street Address/State Road/Lot#(s)
/114)A State 2)Y ZIP /1S20 tot 17 Civc Iti0A
(citb ) 620— 'VIOcFax#( ) Subdivision
edAgent Mote Opole hey City /4rhiOSis41( ZIP 25191
Cw f Ew PTA ErES ❑PTS Phone# ( ) River Basin
-OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body C✓oo i (nat ,q
PWS: ❑FC:
yes / no PNA yes / Crit.Hab. yes / Closest Maj.Wtr. Body /1014)
Project/Activity 1$1/)DZP) p/D)PC� 1`6 -to pot i n ' 40/A A,t
I
(Scale:
:k)length
i(s) -
ier(s) _
ngth
nber
4Ntiprap length
distance offshore ( j/
a distance offshore
iannel
)ic yards
rip
Ise/Boatlift - r J. ;PP'
ulldozing _ tot i7
(' fie ) .
e Length 86f •
not sure yes
s: not sure yes n
n/a yes no
yes no
kttached: yes
ng permit may be required by: r-i See note on back regarding River Basin r

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
jj�� , 1 L¢t7
Name of individual applying for permit: -UO9 V i \ verO N
.Address of property: Jl 6 Av 2/
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they 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 Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
WAIVER SECTION
(Does not apply to bulkheads or rip rap)
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
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.
4)(/// ,‘27#711 9-4L V.5 --- .
x S gnature Date
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Print Name
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
( 1- 1* /7
Name of individual applying for permit: ID()VG, 1104SVe ra !V
Address of property:r -6I e1\)t(A. Po,* d r, 'co r n43 on )0(/J507,1 isk/
I hereby certify that I .own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they 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 Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
objection if von have been notified by Certified Mail.
• WAIVER SECTION
(Does not apply to bulkheads or rip rap)
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
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.
Signature Dale .
��tT » s: [OR a ��. r
/` Print Name 6 _
Telephone number with area code

�ry
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FIRST CITIZENS 365
BANKAr rI Firslp tizons B nk 6 Trust Company
J�"1.t.lam Hampstead.N.C.28443
www.firstcitizens.com
For CreJ/D`fcI -b '_,NWP
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1:053 L003001:00353 20 L La030' 0 ? L9 2
COASTAL VIEWS^WOCV