39045D - Clardy

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I'CAMA/ il DREDGE & FILL v
3ENERAL PERMIT Previous permit#
iNew Modification ❑Complete Reissue CPartial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources r-�
2oastal Resources Commission in an area of nvironmental concern pursuant to I5A NCAC ( t'1 • 1 2CO
1 . ` D et r,,t 1'Rules attached.
it Name L 1 �' ` C(et''47
Project Location: County ?e'' t-y'"
fl S 6. N);1 A vm'Ortt C. r i c Street Address/State Road/Lot#(s)
(-4 q�.r'S-� +Cr,Pi state NC ZIP Z y43 954. W ;i LA,oral it /-c•1 e
('9 0fl) 2.7 D -003 Fax#( ) Subdivision GP‘-...( 14Cfr t v ---
:ed Agent City ?mil^-%(S{e4d ZIP
XCW >(EW jerPTA ❑ES C PTS Phone# ( ) River Basin eye
ElOEA El HHF El IH ❑UBA ❑N/A Adj.Wtr. Body ar`"^c L o r V�"1.^'�' k' na)/
❑PWS: ❑FC: _
Closest Maj.Wtr. Body V O.r9 '"yes / no PNA yes / no Crit.Hab. yes / no
'G C k
F Project/Activity /V QW 1 + e ✓ 4 T- I-I e.Gto(
(Scale: J""
)ck)length 55 'f)c (T'�f9 r )) _,/
n(s) 14' k 16 I - 1,_
,ier(s) r I Cf
;ngth I
: i ; V,1,) n n r -7-Pf. 'f.�
amber Li . 13e'd,' k .
id/Riprap length r_..c yeEl �r
g distance offshore f L.. "' s!; "y` '+
ax distance offshore 1 4g �._- ,� -t +-
hannel I 1 1 iu } i
ibic yards r] � iF I ' l' 4.
mp -- t .
+
use/Boatlift r it 1 1 1110/
3ulldozing 1 1 �
11 a i i' I I
' ! i t--41 ' I 1 _,
ie Length n n ,, h - i/
not sure yes 41 l ,
gs: not sure yes }
rium: n/a yes + ---
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yes A• _ �1f� Ewf* 1fi h i 1
Attached: yes
ling permit may be required by: Pe c 1 Cot-ert 1 . 17 See note on back regarding River Basin 1

, GENERAL PER-11T COM PU TER FORM
pr C."'N T N^M-: (ip) ) i Gi rh 10 e V. 4 (1 I rd y
)DITION 1 NAMES: /
iC D`SIG: G�I) 6w 1 �� DEVELOP OP.=.R =_:_0.01 PROJ DESC: I - I Z
i1 only ta::6) (Vvi11 onix tai= 1)
DR-K: F R 55 C, TE 6 1 `i
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ACTION �IRATION
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\ {A?VLAJORDE ELR>;QU : 9/ 0 I0y 1/1el°14

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORD
Name of Individual Applying For Permit: GAJ i 1 //- b
orrC-f
Address of Property: 'g 5-6 r ) R (it) 00 C C
(Lot or Street#, Street or Road) e
(City and County)
I hereby certify that I own property adjacent to the above-referenced property.
applying P P rty. The indi
for this permit has described to me as shown on the attached drawing the developmei
are proposing. A description or drawing, with dimensions, should be provided with this let
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Cc
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395.
within 10 days of receipt of this notice. No response is considered the same as no object
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat set bck a minimum distance of 15' from my area of riparian access-unless waivedlft by me
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.
Cu Name Date

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NOTE: Q I p NLLfL w I
PROPERTY LINE IS EDGE vs,, 'O'S°' I '
OF MARSH, (HIGH WATER • I . r
LINE, SALT WATER) OF : 1 =• r 1'
CREEK OR SOUND 2
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r ER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
mplete items 1,2,and 3.Also complete A. Signature
n 4 if Restricted Delivery is desired. . • f�� / ❑Agent
nt your name and address on the reverse ❑Addressee
that we can return the card to you. B. eceiv b (Pri d me) C. Date of Delivery
ach this card to the back of the mailpiece, ---7—� --
an the front if space permits.
D. Is delivery address different from item 1? ❑Yes
cle Addressed to: If YES,enter delivery address below: ❑ No
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I- CERTIFIED MAILTM RECEIPT a--3 �\
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u'I For delivery information visit our webAsite aLt www.usps.com® �_
, - by f l t' C•�740i USE.;•;:'. 0 i r'?L ' ,,,
m Postage $ $0.37 , r -
I.f7 Certified Fee $2.30 0443 r
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1=1 Return Reciept Fee $1.75 Here
D (Endorsement Required)
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Restricted Delivery Fee
1—▪, (Endorsement Required) t0.00 ( _ _ -
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rq $4.42 06/15/2004 1 I 1 r_ {1}
m Total Postage&Fees $ ` }.ram _
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or PO Box No. /r,2/( /r, `r �,
City State,ZIP+4 6� , m
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PS Form 3800,June 2002 See Reverse for Instructions %
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