38994D - Massengil

, 4/I-CAMA/ G DREDGE & FILL /3
;ENERAL PERMIT Previous permit#
l'New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
lzed by the State of North Carolina,Department of Environment and Natural Resources -�
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 17 H. j I 0O "7H• /3 C G
❑Rules attached.
Name ' If 0&J'$Q - Li' ) Project Location: County °^s10CAI
I) 04 E..c4 M t'/b e f V �4 Street Address/State Road/Lot#(s)
>eitf3b0c0 State&le- ZIP z753 0 / 2-7 (0n0 g ']7
('VI) 731 - ZZd6 Fax#( ) Subdivision II06Aif "TT/ ( y,-fq) (,,,4
edAgent Sieve iln-� ,/rr : CitySnQGC(S Fe. (e7 ZIP Z8tfb1
❑Cw W %PTA ,WES ❑PTS Phone# ( ) J River Basin IA/h:--1
❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body e4 (nat /
❑PWS: ❑FC: �'{
yes / PNA yes no/ Crit.Hab. yes / no Closest Maj.Wtr. Body ei 4 w' r k va
Project/Activity l(jFZU/ 10/ tieQt i4 bo' rei.- 2
/ (Scale:/// IA
:k)length
(s)
I j_
--y
er(s) j
igth
//'
nber }f j
.17 Rip rap length
distance offshore __ '_— V
x distance offshore /� N.1 annel i 0
f I i
{i�,
sic yards P
-,»
s
i r s r
e/Boatlift
A . Nb 14 :- — _ —�i--
I '
11/491-1L—
ilidozing I
i i /zi' . "de -Iza
_
♦nA r
t
Length 1 f,® n1SCL _ � ,.....
not sure yes no.} . 1p. t b
;: not sure yes no -
I � , rt_
— _
um: n/a yes no t 1. ,_
-t
yes a i _q
attached: yes /_�_ j i . [ i I
ig permit may be required by: .1510W CA u'1 y. . I I See note on back regarding River Basin rt

GENERAL PERMIT COWL 12ERFORM
kPPUCA N 1 KJV : i / ( I ei R-S'S a 1 I
ADDITIONAL NAMES: S-1eve n4 ;%.-.or; P - 13
AEC D SIG:ELO PTA ES DEVELOP 4R —D.0 5 PROJ DESC:17 -
(Will only ia: 6) — (V:71 only Ink:1)
WORK: 611 I I 0 "� .r 1 2-) 2_S
(Win only'Mk:4)
(M•'l1 only tan 4)
MD: 513 2`7O � G MOO
(x 11 only tik 6)
ACTION P RATI ON
D.R.EDcE •-ram.pEQT..TIR= 7 1-1 `I
CAMA MAiOR DE L REQti : '7l z/o 'i /0/7 /© `f

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO 1"I1-ICATION/WAIVER FORM
ne of Individual Applying For Permit: 4 5 ", (4„,
cress of Property:
(Lot or Street #, Street or ad)
(City and County)
reby certify that I own property adjacent to the above-referenced property. The individual
lying for this permit has described to me as shown on the attached drawing the development they
proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
ou have objections to what is being proposed, please write the Division of Coastal
iagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
tin 10 days of receipt of this notice. No response is considered the same as no objection if
have been notified by Certified Mail.
WAIVER SECTION
derstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
Ick a minimum distance of 15' from my area of riparian access - unless waived by me. (If
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.
Name Date
♦w.7.

Jun- 18-04 08: 17A Jackson' s IGA 910 296 2092 P.1
vt.,{...•f.Vvy aV,O. 21u—)L{—Z4(:) MI1NUfK1 MAK1Nk cUNb PAGE 01
Y; . ;S `�`t'. •+. K AGEMENT
t'
✓
Name of Individual App • , ,{ "
Address of Property: '--
.r :a .v •P hf
at' 4• ,. �s s 1 r ;s
(City 4
I hereby certify that I �" .• ,r' '�. sabovc'.'Tefercnccd property. The individual
applying for this perniil ' _' . .Ys�...'• 'r,y, ,. the attached drawing the development they
are proposing. A son ,4r ` a ; `'* •inns,Should be provided with this letter.
J F �1 0 t y
n $ l proposal.
s
If you aye objections•lie6 please write the Division of Coastal
Management, 127 Car , ;• , :: aeon NC 28405 or call 910-395-3900
within 10 days of receiptY
{
; , �,1a4 11e Considered the same as no objection If
you have been notified ►• Y' ;
C „ ,may ; =
I understand that a pier rt ,' ' . akwmter, boat house or boat lift must be
set bck a minimum eta v t:' ' t+p iparfuo access-unless waived by me. (If
you waive the ` ,";appropriate blank below.)
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ORDER OF L .�� �
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MEMO 4P 327/y AUTHORIZED SIGNATURE AP
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0004260 1:053000L961: 00065052L990o