39061D - Gibson

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CAMA I ❑DREDGE & FILL
3 E N E RAL PERMIT Previous permit#
:New Modification —I—Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina,Department of Environment and Natura Resources
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7i/i, /7U 0
,� ❑Rep attached.
t Name / P/ <�'".•'J S d r ,� Project Location: County �or1.f•✓ �o .
w / /9 ) c 444v AIM f Ror Street Address/State Road/Lot#(s)
4m p s fera de State WC- ZIP 259115 Ja, -,
(q/D)2 7G /9S02Fax#( ) Subdivision
:ed Agent City - ZIP
E CW YEW IiIPTA DES ❑PTS Phone# ( ) River Basin
E OEA ❑HHF ❑IH ❑USA ❑N/A Adj.Wtr. Body t144 6 no / (nat /f
❑ PWS: ❑FC:
yes / no PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body yfrilld le>
r Project/Activity /34.11/ji I'n .7 id,'"/ d' 7,4 a t,err7J Y G�L
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(Scale: /
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ngth f {
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d/Riprap length
distance offshore
uc distance offshore ; —
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ise/Boatlift I ' ! i
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not sure y no a: not sure yes (no I_ y }_..
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lum: n/a yes no ,—
yes no ❑ 1 ' 4
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4ttached: yes l I I !
ng permit may be required by: A41,0/ ! , . n See note on back regarding River Basin r

GENERAL PERMIT' COMPUTER FORM 31061 YJ
itONAT N=MESS:
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DEV:�.OP��=-� SC PROJ DISC: ft- IL
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ACTION a-PMATION
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A MAJOR DEA=REQU =- :

R:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
Mete items 1,2,and 3.Also complete A. Signatur
4 if Restricted Delivery is desired. Cl Agent
your name and address on the reverse X W. (1, 0 Addressee
at we can return the card to you. B. Recei by(Prriinnte. Name) C. Date of Delivery
h this card to the back of the mailpiece, t.i 1` G� • St t
the front if space permits. �V 1 J
D. Is delivery add=. ,a :11111 1? 0 Yes
Addressed to: If YES,enter relive re el9t ❑ No
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C5 V5-/ 0 Registered 0 Return Receipt for Merchandise •
( ❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
Number
fer from service label)
3811,August 2001 Domestic Return Receipt 102595-02-M-1540
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: /l1 e/ 6? b So".
Address of Property: Gof" / q /—t)c/4)7 ?o t ►eo q d.
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The indivi(
applying for this permit has described to me as shown on the attached drawing the development t
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 objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift muse
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.)
C " I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
ILO 49-1Lo-- 9/24
Sign Name Date
Print Name

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order of.. . . . *-------- ilti° il'./(///j\fi-.J 4�: !� 1 e CP
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Wachovia Bank,N.A.
ACH R/1 053000219 • p
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