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CAMA and DREDGE AND FILL " 2�421'!�.
G E N E R A L l :
P E R M I T G- p S p 0 08 IC A
as authorized by the State of North Carolina
> ,....: Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 11.1 . i 2 00 .
Applicant Name C ' cc-'r le ,� \(t-Ac Phone Number ab`7- 3Z I
Address )141S {`\,c\l., PIrNC ( �,t.)rr k k'or d
City `:•:\--c_ buru State N ..) Zip %.-03
Project Location (County, State Road, Water Body, etc.) c u n �W-t C�- ( u mi‘ ) I 1 00 Li 4+1C.,,,,
S - A 11 A k k' ,of-,r TN>r-,J' tA' he 11 o-1 , I CJ ,2,,.\ Ilo 1 t-- k'1 0 f
Type of Project Activity 1\. .. .J Ps€--r` ' du'`k-_ , I tof -k tr•<< c oc , bo(N-k Imo )
- rnus4 t. 4\ c u tr,pl,r}1,ct_ u;,+-1, A \\ C. or.a., ivv,s on '14 t . 1W- Ft-ty) ((red
PROJECT DESCRIPTION SKETCH ' \ i 4- e - (SCALE: t,..)C.) T )
Pier(dock)Length IA in tt,-4.
Groin Length
II 111 III
number
Bulkhead Length Ar- , � 1t'Imesau 1
II ng. 11 .: 1
max.distance offshore II r 1 ir obitiBasin,channel dimensionsal •
s .
___.. ..._... ... , t i_4_,_ .4
cubic yards , µ
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Boat ramp dimensions V
a t . t t._."._ ,,
Other �r X a�. `I S,f III i E,' '
7uA} ` NUU � 1 r ipiff
rx 1U' 1 Inrv� ics
II
_..: v.. 1 o ,/...e a II ..., Eiti ' - . - 1 al LIM
Pilfillare ;I
odiaiamiiiiiii --- , a _..• , -NW
This permit is subject to compliance with this application, site drawing l�ii ! �, , tc2 �
4
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 -� r
may cause the permit to become null and void. , T`1 --_.Q.-.-`-,- "
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- J iI 6 I O 1 O / (c3 I
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 ri
been obtained from adjacent riparian landowners certifying that they 1 • 120° " `e.-1 . . 1.4\A
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 'C-C). '---
is consistent with the North Carolina Coastal Management Program. application fee

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nwrsToN OF COASTAL MANAGEMENT
• ADJACTArT RIPARIAN PROPERTY ONNIZ NOTTFICATTON/WATVER FORM
•
. .
- .
. _
. . .
Name Of Individual Applying For Permit ell a V k E Irot o -k
Address Or Property: llog )411e IAA. Atter -II)'.S.W• ti-of Jig -hialtfoilf tf1( Esivk5)
( ha(Le N.e. Trims Etia _aoLua4-v
(Lot or Street#, Street or Road, City & County)I
I hereby'certify that I own property adjacent to the above-referenced property. The individual
L
applying for this permit has described toifte 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 objertinns to what is being proposed, please write the Divisioi of Coastal
. .
28405 or call 910 '395-
'1900 within 10 days of receipt of this notice No_resp-onseis considered the same_as no ohjertion
if you have been notified by Certified Mail
WAIVER SECTION
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.)
-- - - --1de wish to waive-the 15' setback-requirement.
I slonot wish to waive the 15' setback requirement.
•
/ a
Signature Date
e p-c Ashomftwa.
Print Name NcDENR
Telephone.Number With Area Code NORTH CAROUNA DEPARThSNT OF
ENVIRONMENT'AND NATURAL RESOURCES

• .
•--
DIVISION OF ro&STAT.MANAGEMENT
ADJACENT RIPARIAN PROPVRTV OWNER NOTIFICATION/WAIVER FORM
•
•
Name Of Individual Applying For Permit _eivillis E. vecto -l • .
Address Of Property: 110H lofte -River 1r- S.Weibi- Jia IW Apt.f E4.4
•
611411,fic N 33ru7.5wick_ ecuirt
(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 to-nie as shown on the attached drawing the development
• they are proposing. A description or drawing, with dimensions, should be provided with this
letter. • •
_
+have no objections•to this proposal.
_ .
•
•
if ynn have objentions to what is being proposed, please_ write the Divisiol of Coastal
M2rnaement
C2rohin2g4O5 or call 910195-
.1900 within 10 days of receipt of this notice_ No response is considered the same as no objection
if yon have been notified by Certified Mail
• WATVER SECTION
I understandlbat 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 rnrist initial the appropriate blank below.)
- - -- the 15' -setback requirement
I do not wish to waive the 15' setback requirement.
7.2 It AT:7v
r.,) Date
Print Name • NCDENR
exi4Ace....75- CAA
Telephone Number With Area Code NORTH Co DEPARMENT OF
ENVIRONMENT AND NATURAL RESOURCES
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7T/.ir RG Mara T 1( O.l
BRANCH
AND TRUST COMPANY �I -�'/ /L- NI'
B 0 RANDOL BANKING v
C11,-0,..jk,
THOMASVILLE.NC STREET7360
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P!� 900 5 56 ' ��rw� N�
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