37831D - Gavmont

_1CAIV'A/ J DREDGE & FILL
3ENERAL PERMIT Previous permit#
4New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC r7 • /2 0 G ']Hl • Z 2_0 0
'Rules attached.
[t Name To L,h A --,e h f Project Location: County Q 5/0 1/4.ti
- `1 C i „d ate':ek .SLorc S ')✓ Street Address/State Road/Lot#(s)
5-no445 Fiee1 State NC ZIP 1Z ' Cl,adw•.ck .0..,..)rc 174'
E R'I 1 )31s-8-)4r' Fax#( ) Subdivision
:ed Agent City _ 'i el"(d s Fe r'v ZIP
❑CW `,SEW PTA ❑ES ❑PTS Phone# (1I 1 )3(15- ►I River Basin (1 dye
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS: ❑FC: Adj.Wtr. Body C 1-, el w;c f [�c,- at /i
yes nod PNA yes / no Crit.Hab. yes / no Closest Maj.Wtr. Body C kokd4w'`C k ,�4
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ng permit may be required by: Q yes lot.,, C,e I.,t v -4 y 0 See note on back regarding River Basin r

.3') 83
GENERA M; PERMIT COMIPUTER FORM
?PL I C-_'\!
pDIDON.=_L N a 1vES:
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�C DESIG: DEVELOP R i 0. O ( PROJ DESC:
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• ACTION D:PIlZ4TI ON
z&FILL REQUIRE..?:
LMA MAJOR DEVFL. REQU :

Mai Tai Inc John& Teresa Gaumont
111 Henderson Drive 804 Broadhaven Dr
Jacksonville, NC 28540 Raleigh, NC 27603
2/25/04
Dear Sir,
I am the property owner directly adjacent to you in Chadwick Shores in Sneads Ferry. I
would like to obtain your permission per the CAMA regulations to extend my existing
dock out 4 feet, add a boatlift, add a jet ski lift, and place a piling in to hold an Osprey lift.
I have attached documentation from CAMA describing the above project, and would
appreciate your consideration and approval in this project.
If acceptable, please sign and return the attached documents to me in the stamped
envelop provided.
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
Kindest Regards, • Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. C
• Print your name and address on the reverse V C
so that we can return the card to you. Receiv=• by(Pw ted Name) C. Dat
• Attach this card to the back of the mailpiece, ',h i kl n
John& Teresa Gaumor or on the front if space permits.
1. Article Addressed to: D. Is del' ery address different from item 1? C
If YE ,enter delivery address below: Y
el Al. TAi c_
ilr ?I-JP)", 0(
�h (YIJ0 1/J U.l/ ,(�(.- 3. Service Type

DIVISION OF COASTAL MANAGEMENT
• ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
game of Individual Applying For Permit: -Nt-//c1 �.gv,-tvw✓ ;r
Address of Property: 2 9 (24 a-o Silor-- 'S ! ,r- .
(Lot or Street #, Street or Road)
S:',"7)L'" fr-"L"."-/ZI" ::-;Z(:„:4} 6t)
(City and County)
[ hereby certify that I own property adjacent to the above-referenced.property. The indivic
ipplying for this permit has described to me as shown on the attached drawing the development t
ire 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 151 setback requirement.
Sign Name Date

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DIVISION OF COASTAL MANAGEMENT
• ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: "/%� Jil UM Ow T
•
Address of Property: 9 &Ad ee//c',/< .3ho
(Lot or Street#, Street or Road)
`
Al,Et�r.� j 7.oe, y, /Of OV
(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
are proposing. A description or drawing, with dimensions, should be provided with this lette
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co'
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-2
within 10 days of receipt of this notice. No response is considered the same as no objectil
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Sign Name Date
11 ., _ /_/ / i ., //,_ AF A

U.S. Postal ServiceTM
CERTIFIED MA`LTM RECEIPT
(Domestic Mail Only;No Insurance Coverage Provided
For delivery information visit our website at www.usps.com.,,
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Postage $ $0.37
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0 Certified Fee INIMI 04
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nI l�r O Return Reciept Fee Postmark
■• ' ' rJ (Endorsement Required) Here
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u1 `'f.y (Endorsement Required)
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i.0 r m $4.42 02/26/2004
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✓ ® Total Postage&Fees
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PS Form 3800,June 2002
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ru AVENT FERRY STATION
RALEIGH, North Carolina
r 41111110
QMI i
276062720
r q n U1;26/2004 3631970171 0097
[phone] 10:17:15 AM
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P_11roduct _ Salts Receipt _
Description ortle Unit Final
i _ _ y Price Price
�' JACKSONVILLE NC 28540
' A First-Class 07
Return Receipt
Certified $2$1 75
4 I 30
It
Label Serial #: 14 57
70033110000624714257+ Customer Postage
z , Subtotal : -$0.37
Ft.--
F, $4.05
rn F-+ I Issue PVI: $4.05
9 pa-
CD I Total :
$4.05
�.�V .. Paid by:
Cash
Change Due: $5.00
-$0.95
)111#: 1000301473442
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