38509D - Fusco

CCAMA/ K DREDGE & FILL
Q"ENERAL PERMIT Previous permit#
N6w ]Modification `:Complete Reissue "'Partial Reissue Date previous permit issued
prized 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 j l ('/ H Z 0 G/ 7 N S 1
❑Rules attached.
it Name 7 o h 01 Fv SG 0�_/ Project Location: County 'Pe 0 c .e✓
i( C .,�f; c e(ti000l go/ Street Address/State Road/Lot#(s)
/P/W/1/k State6r ZIP OM 5q 4,64 Itt ri flail 0,,d .9A 1 j
6(203)7Z2--72ZZ-Fax#( ) Subdivision Alo II c ,d 3a‘1
:ed Agent 1 On.1 MO re i'_1 City City f i of e S�cowl ZIP 2 /3 il
CW {4 ,W PTA g s ❑PTS Phone# ( ) River Basin Cy e
E OEA ❑HHF ❑IH ❑UBA ❑N/A i
Adj.Wtr. Body Ca n.a j (pat
❑ PWS: ❑FC: ee
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body r1 ? t�
f Project/Activity Net„/ !,v/khc't4( I &ecf, S ; inc( e'11141:14¢,',ok-ICP cited)
itf -t(oci-).. dock-
(Scale:/"...,..
ick)length 2t)'x(o F I ocpf e r
— / ,Ant ---IJ ;.ter-I 0/ 6 4t jcc t
Aer(s) i - C l OI ri d is D e if..ai ea l ewe d ' ;.. •� � P:, 3; . -:
;ngth j )11.5rip lh 6leti r•' - , ' _ '. - '
amber CAN
/ '
i [ 1S11
d/,Riprap length L. I } i-- _ jF l -1 - !�.J—
g distance offshore 1 j L _
j l +
ax distance offshore } i 1.-- i
,— i 1.
hannel 25 X 2.5 5 !© - cS 5-re M..
t
bic yards "'/ I 0 — T 5 rbei ...... I—
-i
use/Boatlift i
— — , 'a _ �
t t 6- - !- i
Iulldozing 'i'' of TIP AC r' -LI ". O C"I)Cc 5. .iba
644/
Up(a 4 eC1. 1 t 'Z 71 j s/ f/
h i
n t 1 I i j
ie Length's /..) ip fat e1-ilt y —._.. .......-,—. r�
not sure yes no -z's!LC -- 1 T/4r n' .. i .1 d n 1 r
�+...� f
s: not sure yes no + h
'ium n/a yes no t-_ —.
yes no i f ! 1 -1 Lei, 1
Attached: yes no T' 1 1 t I 1 1 i
O
ing permit may be required by: �" ertd e'r f ov'd 4 7 . ❑See note on back regarding River Basin r
_ . . _ .---",.• a —__ 1 _ .._• • . • i i _ J _ s --1 1 '/ •...... , i r

3i so/ ►e
• GENERAL PERMIT CO TPUTER FORM
ti0 In Pasco
p - Il
I_1 ONA = =S: pZ- !
D S1G: DT=V p�.OP�:`z_ O. O PROJ DESC: /0 - 15
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ACTION D?mATON
)_ _ R:EQUA:
AMAMAJOR.DEVE.REQUIR—D:

ADJACENT RIPARIAN PROP --- ��ERTy OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
0 �►� � �� � �o
Address of Property: 1,0\ "- (
(Lot or Street#, Street or Road)
\ -\P'Syti, >SZ C Y yL
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individu
pplying for this permit has described to me as shown on the attached drawing the development the
re proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
F you have objections to what is being proposed, please write the Division of Coasts
[anagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390,
ithin 10 days of receipt of this notice. No response is considered the same as no objection i
fu have been notified by Certified Mail.
WAIVER SECTION
inderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must bf
t bck a minimum distance of 15'from my area of riparian access-unless waived by me. (II
u wish to waive the setback,you must initial the appropriate blank below.)
I /Ai I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
fir.. 74,4( 5/2 o �l
n Name / Date
f1 e ) �.�� K AAA

it
SL
Se , 4
r•
��-ti\ \ side

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: C, 0
Address of Property: L YT -f - p '_`l.) .
(Lot or Street#, Street or Road)
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individu
pplying for this permit has described to me as shown on the attached drawing the development the
re proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
you have objections to what is being proposed, please write the Division of Coast
lanagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-390
ithin 10 days of receipt of this notice. No response is considered the same as no objection i
fu have been notified by Certified Mail.
WAIVER SECTION
inderstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must bE
t bck a minimum distance of 15'from my area of riparian access- unless waived by me. (Ii
,u 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.
,2,„_ r1 r/'%o , &/--c,A / 0
n Name Date
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