39739D - Jenkins

CAMA/ I DREDGE & FILL _
ENERAL PERMIT Previous permit#
New -Modification ❑Complete Reissue Eli Partial Reissue7 Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7/S!/2�
--��-- ❑Rules attached.
nt Name Z2le �/�k. t.n5 Project Location: County 8-,,,,,,�,,.:c,E:.
11O 5 ,1LII ; /75 , c 6.c , f Street Address/State Road/Lot#(s) .2 8
A.- e !.-t 5 r`c. State ffC ZIP 7-76-I41 L6eii,};Cr/L t ci:57Lr-e-E V'
( 'q) F98- f/L,o Fax#( ) Subdivision
ized Agent yc-5,f 2)ocA S City .!7eeo.7 /s/c 5ea-64.- ZIP i f'/U
d IIICW JW X PTA ❑ES ❑PTS Phone# ( ) River Basin Lt..;
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body C6 iicz.( (nat,
• ❑PWS: ❑FC:
yes / no) PNA yes / t�b Crit.Hab. yes / no
Closest Maj.Wtr. Body f-//z'-)� ri;i;
Df Project/Activity Cr '�.Srizc �ie.-//,hoc .
(Scale: / ''
lock)length j(,,, x 4
-m(s) x ? r f ! — T
i
pier(s) t i
length ' r`` C. 4 ��jt'r1•.r
lumber I—I j ,�_ � i�
:ad/Riprap length
wg distance offshore A l
nax distance offshore _.._ t t �_._.^-.._
—I" I j— ti
channel
- - l _
ZO .� . Tfi..
:ubic yards
—_: 1 �,. $_
amp — "---
Duse/Boatlift )h, �. ' "�._'
1
Bulldozing l — L
j {
i + -�— .—
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ik7 j�-�t—
ine Length S� .
not sure yes f i �j V J Z
ags: not sure yes cp,
orium n/a yes v H
4 L.....; I._.. i _.. 1 I
r Attached: yes 616 ??. i f
ding permit may be required by: OCZa c Z;/C ee,e�`. . See note on back regarding River Basin
,- . .- .... , / % Y. ., ._ _

GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: %L e Jeu b n 5
ADDITIONAL NAMES:
SEC DESIG: 6-14.)/ ?T DEVELOP AREA:__. / PROJ DESC:P -/z
Will only take 6) (Will only take 1)
WORK: PR2. /G, 41
Will only take 4)
TE 3, 20
VIAINT:
Will only take 4)
[MP: 00 /Go '
will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED: ///30/d 4/ 3/1/4
CAMA MAJOR DEVEL REQUIRED: ///3o/0$ .3/1/4 3

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DIVISION'OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: DQ/l pert kL`os
Address of Property: ,?g, 6tyin bofS.I--
(Lot or Street #, Street or Road)
O8
(City and County)
I hereby certify that I own property adjacent to the above-referenced.property. The indivic
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 must
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,Jt `/ I do not wish to waive the 15' setback requirement.
.77
Sign Name Date
l2).-7 fu5s A`F'_�A

COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
1-, c c .--. (3 O
e items 1,2,and 3.Also complete A. Sign- re I m D { o m.
Restricted Delivery is desired. 0 Agent -,� o-1 D r
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it name and address on the reverse X / ❑Addressee : mn ' dcr 0"Y'9 Z
ue can return the card to you. B. Received by(Printed Na C. Date of Delivery o m c�f
1is card to the back of the mailpiece, zm - o j H
front if space permits. F>m y ,
D. Is delivery address different from item 1? 0 Yes A 0 r
dressed to: If YES,enter delivery address below: 0 No
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(1/1/07//h"g/a'S1• 3. Service Type P
MD Certified Mail ❑Express Mail/� ❑ Registered ❑ Return Receipt for Merchandise ={/' , 0 Insured Mail 0 C.O.D.
Ar7[J�y /� 4. Restricted Delivery?(Extra Fee) ❑Yes .0
7 umber n
From service 7004 1160 0002 8822 5792 .+
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811,February 2004 Domestic Return Receipt 102595-02-M-1540-
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COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY 1
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Signature ate items 1,2,and 3.Also complete A. Si g L
f Restricted Delivery is desired. X / O Addressee ent n
,ur name and address on the reverse9e01,,_.7n/
ri
we can return the card to you. B. Received by(Printed Name) C. Date of Deliv
this card to the back of the mailpiece, /n o� n
le front if space permits. `v
D. Is delivery address different from item 1? 0 YesEI
ddressed to: , / If YES,enter delivery address below: ❑No 0
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3. Service Type
❑Certified Mail CI Express Mail 1
1S V (e 0 Registered 0 Return Receipt for Merchandise 1
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/ 4. Restricted Delivery?(Extra Fee) 0 Yes \)
lumbe 7004 1160 0002 8822 5785 e
from. .r►
3811,February 2004 Domestic Return Receipt 102595-02-M-1540 vc �1
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