39060D - Gibson

1CAMA/ ❑DREDGE & FILL
;EN ERAL PERMIT' Previous permit#
New -Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
•ized by the State of North Carolina,Department of Environment and Natural esources
:oastal Resources Commission in an area of environmental concern pursuant to ISA NCAC 7h4, /Z��
/ �1 ❑ les apched..
t Name CJG f/Sf 6;,4 SQ/'l Project Location: County Nu►es l/G:0,
Co f /9 .4 /IliG Kd✓y 6141 /'CO[ Street Address/State Road/Lot#(s)
VA in p 5/7,4/f State/Z ZIP Z'V 9 j 5.0 *1
() 2 t2_ '1ax#( ) Subdivision
ed Agent City , ZIP
❑CW 1LEW `1PTA ❑ES ❑PTS Phone# ( ) River Basin
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj.Wtr. Body Z1:1+.44, (nat 11
❑PWS: ❑FC:
yes / no PNA yes / no Crit.Nab. yes / no Closest Maj.Wtr. Body /42-.le,A.'"
'Project/Activity /50i�/b t,I %i,, P /`iw ii H� dt4-
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i(s) /6 7/ i _. ''' ` __
ier(s)
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d/Riprap length ( { i I —.
distance offshore f -I i_. i
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I + }� distance offshore _ I / &hit Icannel .�_..arcyards ` -` t f _ f —
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se/Boatlift 1 1 i ` I
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e Length_ Z�/t/ `' r....._' t i / 1
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s: not sure yes no ,�
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•cum: n/a yes no j 1 , _ 4 s
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yes no I 1444' -- I
Attached: yes ! I ' i i i
ng permit may be required by: �1'o f PV 6 0 A 4) . n See note on back regarding River Basin r

GENERAL PERMIT COMPUTER FORM 3i
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: /77 e/ 0j 4 S 0 -\
Address of Property: Z.,074"/ q /47/cKoh Po, t Ied q d,
(Lot or Street #, Street or Road)
/43+ 14S-t-e ft. C. ren de Co frit
(City and County)
y
I hereby certify that I own property adjacent to the above-referenced property. The indivil
applying for this permit has described to me as shown on the attached drawing the development I
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 Coa
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3
within 10 days of receipt of this notice. No response is considered the same as no objectic
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mus
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.)
tO "Y I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
`" � X 'a''C$ = 9/2404
Sign Name Date
ttdv ► z.-Ys 0 arpAPrint Name

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ER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
mplete items 1,2,and 3.Also complete A. Signatur
Ti 4 if Restricted Delivery is desired. -El Agent
nt your name and address on the reverse X W Cti: ..(n L 0 Addressee
that we can return the card to you.
Bach this card to the back of the mailpiece, St Recei, by(Prince.Name) C. Date of Delivery
3n the front if space permits. VV M i p"... T. , , 6
ale Addressed to: D. Is delivery add:_ t a4l1!/, 1? 0 Yes
If YES,enter relive re elo 0 No
n- Jr < A y o1‘ Sep 0
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Ia/t 11 �, G. 3. Service Type j
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❑Certified Mail ■ _" . .il .� a, igY,v '` `°
V I 0 ODRetur Receipt for Merchandise 01.,9r� o
0 Insured Mail CO.D. I51
4. Restricted Delivery?(Extra Fee) 0 Yes t u I t F
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le Number ("3
isfer from service label)
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m 3811,August 2001 Domestic Return Receipt n i ' w Ot 0
p 102595-02-M-1540 t,,..,. f_. n
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U.S. Postal Service,. m� ,
03 cr-
CERTIFIED MAILTM RECEIPT t .�'
�p (Domestic Mail Only;No Insurance Coverage Provided)
For delivery information visit our website at www.usps.coms Ca
ru LIO:AD* F:44C1AL USF - . 0 ..-.., 1-7:‘- 4-(..
m Postage $ $0.37 0 i
0 Certified Fee { 043 C
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CI (EndorsementRR sleReqpt Fee $1.75 Postmark er 1-�
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D Restricted Delivery Fee $0.00 �, �,q
ra (Endorsement Required) y
m Total Postage 8 Fees $ $4.42 0?/17I2004 - lit` a
im Sent to .'
o ,(1'►n. 3-Ctcle 6
N S`beel;Apt.No.; on.
orPO Box No. 76 A �/yy '
City,State,ZIP*4 (��1_S_fs� _� . �/ e- t_;s _
e a d Nc a?v s
PS Form 3800,June 2002 See Reverse for Instructions
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