27481D - Shan-Gri-La

CAMA and DREDGE AND FILL , 77481 _D
G E N E R A L
PERMIT poLt1z ► vofi
as authorized by the State of North Carolina D 4 I ZI Co 4-
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC ' I i4 . 1 uU
Applicant Name n if1i� C7r c't — LA it'v(*) 0toner,Phone Number G Its '1,5 : ' q27
.ae, ff W . af04�k-tf .
Address 1`1 a_u s t\Sv.ik l t)
City C)(' ''-r\ rN ' \C . cck State k)(,1 Zip 8`-Ito6
Project Location (County, State Road, Water Body, etc.) ('',,t rnS WI C k- Co t.).sn`I� . e-rv-i of
CA e .<)-k-r-e-P41 hf\ \\v{ ‘_ f ) Ct1 PIT t Jto
Type of Project Activity Net,J P\&- f c� C 1XPC� ' oc - el u r
PROJECT DESCRIPTION SKETCH R 1 W t•J (SCALE: `' )
r ra
Pier(dock)Length !a ,K.C1 U I )
_...T.9R.v x,a-.WO— , _- ..:......S. C• t /. calm{..
Groin Length bfIt .._ PJ2, • c .4c_-- ► nom I. RCM
number dF t A�ACk.....__ .,_.,.... 11111
Bulkhead Length 0 r ti)1/4) «..:.,. . [ F—__!9i . l', I III
max.distance offshore �y bIrian
Basin,channel dimensionsor Le 1
4`c.- e et- Milo -- ^ ., Ilit Et- 1 ' , ":1
cubic yards I. t
Boat ramp dimensions lit11
Other i X cD 11 '_ .»-
E ,v.cd [rock -
II
v l _ ■ ` Pill
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r 'srY riff '
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This permit is subject to compliance with this application, site drawing ,C 6 Li,_�_�
and attached general and specific conditions.Any violation of these terms / applicant's signature
may subject the permittee to a fine, imprisonment or civil action; and
may cause the permit to become null and void. t •Tr1 '-.--. ),v,..-3, _
This permit must be on the project site and accessible to the permit of-,/ permit officer's signature
ficer when the project is inspected for compliance. The applicant certi- --_____--Li. 12, 10k -9- / 12-/( )
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 .7 f . 1 00
have no objections to the proposed work. attachments
In issuing this permit the State of North Carolina certifies that this project I/ \ DO
is consistent with the North Carolina Coastal Management Program. application fee

GE.SERAITIRMIT COMPUTER
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UNITED STATES POSTAL SERVICE 11 11 First-Class Mail
Postage&Fees Paid
LISPS
Permit No. G-10
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.ENDER: COMPLETE T� .re �. fly
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■ Complete items 1, 2, anc' Also complete ' A. Received by(Ple.. .Print Clearly) B. Date of Delivei
item 4 if Restricted Deliv'`i is de3ired.
■..Print your name and address on the reverse
;o that we can return the card to you. C. Signa ure
.04,Attach this card to the back of the mailpiece, / ❑Agent
or on the front if space permits. X / • .t .ai El Addresse
e. Is deliv- €ddre diffe . item 1? CI Yes
I. Article Addressed to: If YES en r add .-low: El No
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ertified Mail 0 Express Mail
93 2/7 9 ❑ Registered El Return Receipt for Merchandis
❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number(Copy from service label)
709 r .5aa() 0°° 7 vY •35 lYYa
DS Form 381 1,July 1999 Domestic Return Receipt 102595•OO•M•095;

UNITED STATES POSTAL SERV- GE s ,;lacs Mail
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PermitNo.G TO
• Sender: Please pn • dame, address, and ZIP+4 in this box •
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Sout A JSLv►c,X, N .C, afYJ7b

DIVISION OF COASTAL MANAGEMENT
AWAc',FNT RIPARIAN PROPERTY OWNER NO'I IFICATION/WAI F.R FORM
Name Of Individual Applying For Permit: S/1an9 rr`la.. •kfofer ' owners- RSSoCr&1',o,1
Address Of Property: S a vn pi 10J e o aye m»b P) )0 a IC`ty Iyd 9 e
Lo-r is( /235 Cfcl,na ol) oAd 09aF Cf\ eRl
(Lot or Street#, Street or Road, City & County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described toli a as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
•
If you have ohjertions to what is being proposed please write the Division of Coastal
Management, 127 North Cardinal Drive; Wilmin.on, North Carolina, 28405 or call 910 395-
3900 within 19 davof receipt of this notice_ No response is considered the_sa a as no oh'
if you have-been notified by Certified Mail Je�tu►n
WAIVER SECTION
I understand that a pier,Clock, 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 mnsi initial the appropriate blank below.)
-I-do wish-to waive the-15' setback requirement. -
I daunt wish to waive the 15' setback requirement.
•
iLoni
4 •
Sign a • Date. . .... . . . .- •-
1#-
NcDENR
Telephone Number With Area Code NOFM CAROUNA DEPARTMENT OF
ENVIRONMENT AND NrauRAL RESOURCES

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101
OBA O L EA HOLDENOCK BULKHEADS _ 66 1215159
DBA HOLDEN DOCK & _ �
PH:910-842-9732 �(ltl'
1502 STONE CHIMNEY RD SW a
SUPPLY,NC 6462 a���
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Pay
Order u f Dek A54--ars 6 °'""" !
0:A CANIAW
DANK I
S pNG 28462 .._..___.. �
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For 753011'OLOL9
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