38499D - Vanderberg

Ii CAMA/ L DREDGE & FILL
3ENERAL PERMIT Previous permit#
"New -Modification ❑Complete Reissue ❑Partial Reissued Date previous permit issued
rized by the State of North Carolina,Department of Environment and Nat Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7// ' //C1 U
❑Rules attached.
t Name b6 v,C( Va,Va tqatt°14.6e1.5 Project Location: County l�r,ei,�2'- /' 4-
/?455`''S .51a,t c /107/ _' 14_1/2 ,, Street Address/State Road/Lot#(s) .38
7a r-.Gf/'Lc... State ZIP (z)i/r,.,r -.fU-r7 .S�'e-e. f
'/'(tei 1 G/! zigZ`t Fax#( ) Subdivision /
i:ed Agent .sia rye(5 137/rl 4Z City C((G i ) (s(C ti(Cc!1 ZIP '2?4(0'
=CW ❑EW ❑PTA ,ES ❑PTS Phone# ( ) River Basin /+;;
COEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body r, << 1 (nat i
❑ PWS: ❑FC:
Closest Maj.Wtr. Body /7 't -t=U
yes / no PNA yes / no Crit.Hab. yes / no
f Project/Activity Con 5*YL 2?' &fru) J&c//-( / '(?O" .-,, ;e.r-it�
(Scale: 111=
)ck)length -
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n(s) _ .... 1 I i i t — j ... ..-.. +
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Dier(s) -+' .
angth
ember fI _�.
I ; I.. x1527-e� " rt ...�. _ _ j
ad/Riprap length '?L) t
Ig distance offshore I E r ....- ---t— -'.
ax distance offshore
:hannel t ; I , I i I
ibic yards r..._ t �... _ t---;- 5 k , —. 1.
A/'
use/Boatlift 1
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ne Length a U I- —
not sure yes 'fio i
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gs: not sure yes 1.6)
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4.
rium: n/a yes 1 �—
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Attached: yes i i i
ling permit may be required by: 0CCa r7 /51e 13Cc'C f- . ❑See note on back regarding River Basin I
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GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: Van de,-, 9
ADDITIONAL NAMES:
AEC DESIG: ES DEVELOP AREA: _.Q� PROJ DESC:
(Will only take 6) (Will only take 1
WORK:
(Will only take 4)
MAINT:
(Will only take 4)
•
IMP: /16
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: ?/570 gri 4/5/G/71
CAMA MAJOR DEVEL REQUIRED: i/5/0 1-/- /5/6#

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'.1-15•?8134 1?;42 Fr am: 1o:5E342p•`4E, r, 1
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DWI SiC)19.,E.GS2 161. 11—;,16QT
A JACErr ?_ AN 9PE TY QAPNEA mcA ..i!yy"" arlatm
Nuanie of individual Applying For P��' 1lit; J)niid Va nd en bereQ
.,,. .--�..
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Address of Property: 3 lAii I ryil xvi foj'i5t.
(Lot or Street#, Sixt or Road)
,Ocectn5sle h NC 3/ean560(red(„1_
(City end County) i
1 hereby certify that 1. own property adjacent to the above-referenced property, The individual
applying for this permit has described tome 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,
It r�ax ilavc objections to what is being proposed, please write the Division of Coastal
iManag rent, 127 Cardinal Drive Extension, Wilmington, NC 28405 or nail 90-395-3500
within 10 days of receipt of this nonce. No r'rsspor>tse is considered the same rig s•f> r4;w2etiort it.
7;10 a have been Lwtlfied by Certified Mail.
WAI'VER SECTION
i unders•taod rbat,i pier,tack, mooring pilings,brtsalrwetor,boat house ur bout lift must be set
bck a minimum distance of IS' from my urea of riparian access- flrrlcss wrrlvod by me, (If'you
wish to w•.ave tilt setback, you must ir�itlal dle appropriate blank below,)do wish to waive tlhe 15' setback re urment. EC EVZVE
z---
i .. wish to w!�:ive the l.5` setback requirement. NOV 3 0 2004
COAS AIL IMAONAGGEM
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Sign Name Date_—
Ic -(1 I( i -ftn(
Print Name 14? ji, '' rprA
���� ���� _____Monroe, NC 28110 .■'r t.....�..

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R: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
)Ieth items 1,2,and 3.Also complete A. Signature .
t if Restricted Delivery is desired. X / ❑�Ag�ent
tour name and address on the reverse c)(7. �� L ddressee
It we can return the card to you. B.-Recery by Print d Name) C. Date of Delivery
i this card to the back of the mailpiece,
the front if space permits. ' L + T(i z — a G
Addressed to: D. Is delivery address different from item 1? 0 Yes
/i�� , � If YES,enter delivery address below:
MI i h o Muvv+o WOODLANDS�IUU��ii O f'st5`-
0 o� n I C 3. Service Type > m r(ALA N ti is
KKI�/ / �J :� �,
gCertified Mail ❑ Express Mail a n n ' �"
Zp I(D Registered ❑ Return Receipt for Merchandise ` s -
o ` Il ❑ Insured Mail ❑C.O.D. p �� ( y� �j ,,,.
4. Restricted Delivery?(Extra Fee) El Yes "'CC �' {' on
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dumber 7003 1010 0000 7019 4722
r from service label)
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3811,August 2001 Domestic Return Receipt 102595-02-M-1540 ! V
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