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CAMA AND DREDGE AND FILL NV' 02�Iig9_�
GENERAL a
PERMIT 1
as authorized by the State of North Carolina P!�T 4 its / Q©6 � � y
t Pie".
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0 Department of Environment, Health,and Natural Resources and the Cq s)4l R s ur eACommission
in an area of environmental concern pursuant to 15A NCAC 11�J I
Applicant Name An O5 OE Aka Phone Number
Address/233, M g i i 4 r R k i
City P—u N,p<j 1 ea- State NC Zip ' ll 'o
Y
Project Location Count S to Road, Wate Body,etc.)
3 rc) T
+rtL �-k g ai-' A11/�l NN Ator 144.. f e�, Ii, ert . uN, .� / /,/
Type of P oject Activity J r.. 4 D ' head i ]n 54_ to C! ! h jiC 9 v l 40/(1' :?
�i•. M/1 d ` wt,; 4t. 6 4 Pil d J Co? I+Ion Q104, ) 100
g• ul a 1 3 q /�l
PP 1
PROJECT DESCRIPTION SKETCH -4 , i t/1/W �.. (SCALE: A/ 1 )
Pier(dock) length ` � IV ^i'�
N -
Groin length
number
Bulkhead length /.1:e.3 ,
1
max.distance offshore
Basin,channel dimensions
cubic yards w r 41 V t y Vito' W r r Ij' r {/-10, it,t v
Boat ramp dimensions ,P"XI>�/rt) .r PrJPosed Ar/i;A4h r44 V
Other 1
; . i t
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
\\ applicant's signature
imprisonment or civil action; and may cause the permit to be- . _ � _ C)--24j -
Thiscome null and void. v permit must be on the project site and accessible to the permit officer's signature
permit officer when the project istnspected for compliance. b of l 1, D q — ca / _ 0 /
The applicant certifies by signing this permit that 1) this pro-
ject f
is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no / //v
objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that ;1 �4 0 C �n Vg'''
roject consistent with the North Carolina Coastal a lication fee . /D l ' € /1 G1
this project isapplication
Management Program.

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of individual applying for permit: � (.55 s 'e.
Address of property: I,- Z �A jl f ,0'j43y7,3
I hereby certify that I .own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. (A description or drawing, with dimensions, should be provided with this
letter.)
4 x I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mail. ,
• WAIVER SECTION
(Does not apply to bulkheads or rip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback,you must initial the appropriate blank below.)
74,1 :' I do wish to waive the 15' setback-requirement
•
• I do not wish to waive the 15' setback requirement.
—/Haee,4, /Y-7C— ‘-/S=d i
Si re Date
1 - / i J 1iz7/I"J
Print Name
'--,—/ o) L 'TILL-! r
Telephone number with area code

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• DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of individual applying for permit: SC) (\
property: 11 `C+-V ra 1��/ �id- Hami).5161 /�.)c-
Address of' ro ert�•: �
I hereby certify that I .own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. (A description or drawing; with dimensions, should be provided with this
letter.)
4'&ve
no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or call (910)
395-3900 within 1 0 days of receipt of this notice. No response is considered the same as no
objection if you have beeii notified by Certified Mail.
•
- WAIVER SECTION
(Does not apply to bulkheads or rip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback,you must initial the appropriate blank below.)
2/7
9 o wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
.•
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Signature / Date
krr
Print Name
(o� icy r9Pi 3
Telephone number with area code

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ss-8sr31 /D03:862 SUSAN C. KAYuvoos4o41iMALLARD BAY RD.
HAMPSTEAD, NC 28443 /T,UA"fE� (J! DI. tmAaj dal IAA]) 0
PAY li)111,1E URUEIt UP r
Atzs Qn:`�:'
immq Centura Bank®
1,,wpvnglon,NC 28401
MEMO - - �� 0 `
1:0 5 3 /008 501:0 2 ?005404 ii ):1
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