39006D - Dailey

ICAMA/ ❑DREDGE & FILL
aENERAL PERMIT Previous permit#
INew liModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7//Zero
4.6 FY,S f ❑Rules attached.
:Name _et-L L Cy 5 Y i hit ,-,... Project Location: County en,„
y7 Ccrz cc rr;/ )75 c'c' 7 Street Address/State Road/Lot#(s) 117
cei.r7 /7 State Nt ZIP Z2i5/6=e/ dancord Si"
( ) Fax#( ) Subdivision
edAgent t�vti,) we574' City(_k�4r? /5/C f3cc�iU ZIP 2fl /t'
❑CW ❑EW X,PTA y S ❑PTS Phone# ( ) River Basin Lc i cv
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body Cc,..,.•-7 u-( (nat
❑PWS: ❑FC:
yes / rt -) PNA yes / now Crit.Hab. yes / no Closest Maj.Wtr. Body /9r/-0t4...)
Project/Activity . i;a 7/re t.( 13/74 Z. 1 f c 71 L`x i S{i,7c,r /L c.L f/'c7CL_
(Scale: /
:k)length
(s)
er(s) : I J ' 1
1
igth { I--a 1
nber G --I- - I
i/Riprap length j }
I —_
i
;distance offshore I — , ' rt ._ ..-
x distance offshore j I
annel
4.G
e ,
t T IlC yards _.. -1 t..LY,'� SV 1 }_ ..... ,-
se/(oadi ) /3X/2. t o —
v f r :?illdozing I /5 { G nE
} s1 a
IA,
r ,ctii
i. Y
Length 50 j } 1. I I til/ _ r
s1
not sure yes no
I: not sure yes s
1
Y I.
Yes n
rtrt � t ;—.-
kttached yes LJ i //-- j 6voi c Lill - I . I
1g permit may be required by: c9(' I7 /�K odic//., . U See note on back regarding River Basin rt.

• GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: 5 C r b n e r>Q► 1 c) A
ADDITIONAL NAMES:
AEC DESIG: etk/ Esr DEVELOP AREA:_ . PROJ DESC: 1' - I 1
(Will only take 6) (Will only take 1)
WORK: B(_ 12, 3
(Will only take 4)
MAINT:
(Will only take 4)
IMP: OW I 5(o
(will only take 6)
ACTION EXPIRATION
DREDGE &FILL REQUIRED: (1 3 l 0 (( oL f
� l
CAMA MAJOR DEVEL REQUIRED: (6i 3 /oLfr
( 1 / 3 / bt

D4( 1e. jihok.g.
•
Id
Ylk
• ® r
?0
Nam' c _
� � i—i

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: DQ2‘ 1(.? s'c.
Address of Property: y 7 (7o n e r d . f- -
(Lot or Street #, Street or Road)
• rttnSk) ;
(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.
Et' 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 objection
you have been notified by Certified Mail.
WAIVER SECTION
[ understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must
;et bck a minimum distance of 15' from my area of riparian access - unless waived by me.
rou 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.
dt �= / ( (716 g"/,ate' 77dar
iign Name Date
%/2 c AWVA

- ' biJ
+ 3NI1031100/V O1Od'SS3HOOV NH111311 3H1 dO
1HOI14 3Hl 0l 3d013P.N3 dO dOl1V N3)OIiS 30V1d
SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
•
• Complete items 1,2,and 3.Also complete
A. Signature
item.4 if Restricted Delivery is desired. X ��� /h. [fie vim- C
• Print your name and address on the reverse
so that we can return the card to you. B. Received by(Printed Name) C. Dal
• Attach this card to the back of the mailpiece, 6 A,/ ,,, • ' a r-• -us
&I or on the front if space permits.
Li I D. Is delivery address different from item 1? 1
m 1. Article Addressed to: If YES,enter delivery address below:
to CV
1 1��1sdh
N
N
a 4 ,q s 7
M ��
/n 3. Service Type
j0 — L u.'+1 V k foh/ N��j1 5rr ❑Certified Mail ❑ Express Mail
aJ ❑ Registered ❑Return Receipt for
I
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee)
I
t (o I 2. Article Number
j I, (Transfer from service 7002 0860 0005 3201 4804 —
w 1 PS Form 3811,August 2001
Domestic Return Receipt
p
I Dr
COMPLETE THIS SECTION ON,DELIVER
I u SENDER: COMPLETE THIS SECTION
O AX(\`'�''�r. �
O • Complete items 1,2,and 3.Also complete
EC item,,4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
ru so that we can return the card to you. B. Received by(Printed Name) C. C
.-. ■ Attach this card to the back of the mailpiece,
■■ or on the front if space permits.
I
D. Is delivery address different from item 1?
1. Article Addressed to:
U If YES,enter delivery address below:
co co n1 L (Zh€51" f1iaRRISan
w�_ g �''\ a�' titz �at.�l�' 5
cc z H U <cv in o ! �`' G0. • d �p 3. Service Type
p w 0 }�, ,a o 2 l RO
5� 0 Certified Mail [3 Express Mail
Q.w O �• a N - 0 Registered 0 Return Receipt f
LU Z Z°' w Q i ` 0 Insured Mail 0 C.O.D.
wi G; < 4. Restricted Delivery?(Extra Fee)
0 * .w '1 Op 1 2. Article Number 7002 0860 0005 3201 4811
E. S ^? f l f pi (Transfer from service la,
"'.`i- Domestic Return Receipt
_ of PS Form 3811,August 2001
ri
1
a