39725D - Bos

CAMA/ L DREDGE & FILL
EN ERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natura sources M a�
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 /1 /2 OD
El Rules attached.
t Name n n l J Su Project Location: County 8n��5Gt)/GiS
s 3 13 0 .!-Ott{C Y I ve- Street Address/State Road/Lot#(s) 3/30
5t. - ' State/VC zIPZg4(oZ 1il[ 1e brrvv...
#0/D) ,5gr` 83t"/ Fax#( ) Subdivision Nc 771 vtq L-G L-107, 1
ized Agent LI 2 c/ ki I p�� City iit Ly. ,J ZIP Z8114
d ❑CW YEW *TA ❑ES ❑PTS Phone# ( ) I / River Basin LUN
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body 5 kal ett-G Itti/ -1. {nat.
❑ PWS: ❑FC: Sltal;LC) Qe trl�
yes /ePNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body __
Af Project/Activity Co 1-4C f i e t' -14°GL
(Scale: )11
lock)length 4
pier(s) "X I1O'1OAT I 1I -t
length 11111.11.161111. - 1
umber Ell ■, i
ad/Riprap length
vg distance offshore
nax distance offshore ti I
r 1
channel v
l..rt.. _-F j—t ) ....
:ubic yards i ! ,
amp . a , ,
, , 1
'� V._ _ limn -1-1 :
use/Boatlift ■� rt _� ®®
_ ; R i I ■�
Bulldozing i L T _ _ •-■U�._
■ �� 1'■ '"
f ! 11 --T.
G
nn / 1� V/ V
Inc Length vCt� � � J
not sure yes
■ 11w�■.....� -- , ��
ags: not sure yes no " " ,
orium: n/a yes '•no 1 ' 1 1 ■
s: yes t _. ..
r Attached: yes --
ding permit may be required by: anio SI4-,'C 'i See note on back regarding River Basin
- — -- - rZ// , .-_- _ -.L r 07/J i-7irT I 1 i

GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: hZ 7 e/ S
ADDITIONAL NAMES:
AEC DESIG: > PT DEVELOP AREA: _.G'/ PROJ DESC: P -!
(Will only take 6) (Will only take l)
WORK: Pie L,225 EL ()
(Will only take 4)
TE /2- , /[o
MAINT:
(Will only take 4)
IMP:
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: /1/9 .1/9/0 S
CAMA MAJOR DEVEL REQUIRED: /I//9/0 Li 2/i 9/05

j iJ

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: LA AA ,L, igms
Address of Property: g 30 Stu.c. DR,
(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 tt
are proposing. A description or drawing, with dimensions, should be provided with this letter.
44) I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coas
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 objectiot
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.)
I do wish to waive the 15' setback requirement.
r I do not wish to waive the 15' setback requirement.
-7-0
Sign Name Date
AMA

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: I—Aa y✓ � s
Address of Property: 3 3 0 6 L,u E V R
(Lot or Street#, Street or Road)
�• R rtt Alf�.f-/v eR u.A.)9 a.f -
(City and County)
I hereby certify that I 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 the
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 Coast:
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390
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 sE
bck a minimum distance of 15' from my area of riparian access-unless waived by me. (If yo
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.
J Sign Name Date
/ - 3— DLI
47/ A-i`c AAA

DA I I
PAYTOTHE
ORDER OF N /00.
—
�� DOLLARS 8 �;o,�•••
0
State Em to ees' Credit Union
Salisbury,North Carolina
as �iJ ,.f 4�d[ 3s 7
FOR [ ,3/ re t
I: 2 5 3 1 7 701. 91:08E, 243 100 110 7 16