27371D - Jeffs

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CAMA and DREDGE AND FILL Sra1 I�•'Li tQ I„v 27371
GENERAL
PERMIT
as authorized by the State of North Carolina
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Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC ? FI . i.., o J
Applicant Name 1ti ' 1{ /
34- S Phone Number ( 611 O) 3.)-iS " 1031
Address 7Sy /V . 4.4e, RSo^- 31 , tj
City T-o p c ti'. \ vAt. 0 State N C Zip e /V $
Project Location (County, State Road, Water Body, etc.) SAm, / At J A'a-v R A AA r S CI-(4-N&L)
p_er. :*- (A'
Type of Project Activity f .c�c t 0 t" L : .--1 -1- 'c-•1r S�] Al c. PR; V 1` ' 1° L I(
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PROJECT DESCRIPTION SKETCH (SCALE: / _ .5tJ )
Pier(dock)Length IIIIIIIII IIIIr .,
1 m
Groin Length
number (` - V '
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Bulkhead Length
max.distance offshore
CC__
Basin,channel dimensions
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cubic yards i4 It
• ,•o ! t 1, r s
of
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Boat ramp dimensions i
Other L- r 31 l Dn Xf'J «-_ _ 11 [111
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This permit is subject to compliance with this application, site drawing
and attached general and specific conditions.Any violation of these terms`x_ applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
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may cause the permit to become null and void.
permit officer's signature
This permit must be on the project site and accessible to the permit of
ficer when the project is inspected for compliance. The applicant certi- b 7 _ I .2. 0 I / 0 / 3 • C-'
fies by signing this permit that 1) this project is consistent with the local issuing date expiration date
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they 2 f( - /c)
have no objections to the proposed work. attachments
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In issuing this permit the State of North Carolina certifies that this project /� r ,
is consistent with the North Carolina Coastal Management Program. application fee

CODES FOR AEC DESIGNATIONS
"OH" - Ocean Hazard "PT" - Public Trust
"EW"- Estuarine Waters "CW'- Coastal Wetlands
"ES"- Estuarine Shoreline "FC" - Fragile Coastal Natural/Cultural
• "PW'- Public Water Supply "OR" - Outstanding Resource Water
CODES FOR PROJECT
"P"- Private-usually an individual "F" - Federal
"C" - Commercial "L" - Local Government
"U"- • Utility "H" - Housing Development
"S" - State "0" - Other
# CODES FOR PROI DESCRIPTION
"11"- Bulkheads,Riprap "16" - Utility Lines
"12" - Piers,Docks Boathouses "17" - Emergency Repairs
"13" - Boat Ramps "18" - Beach Bulldozing
"14" - Wooden'Groins "19" - Temporary Structures
. "15" - Maintenance of Basins, Channels,Ditches - --— --- --._..
GENERAL PERMIT -COMPUTER FORM
APPLICANT NAME: NY I t s •
ADDITIONAL NAMES: •
AEC DESIG: r'W 1 DEVELOP AREA: O.° PROJ DESC: P -
(will onlytake 6) -- (Will only take )
WORK: b C. 1 Z ()-
(Wll only take 4)
MAINT:
(Will only take 4)
IMP: 0w 1LIti
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED:
CAMA MAJOR DEVEL REQUIRED: 0-7-11--c) C io'13 •

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of individual applying for permit: 101h1
,-.,..1 tor / k1C .
Address of property: v l "7 V - 0 1�X7'1 l-157 0 c) , `•c- c
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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.)
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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 von 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.)
1 do wish to waive the 15' setback requirement
/
I do not wish to waive the 15' setback requirement.
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'Signature Date 7 v
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P Name
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Telephone number with area code

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