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/A CAMA AND DREDGE AND FILL
4•1 GENERAL
K---"Ncr.) PERMIT , .
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC '
mA _
Applicant Name r ' `kr i< ( I `t t TC EI ' C/O 1.7)1Y1 WICM r5 Phone Numbe�gt�7SS
Addresst - , II \)
3 Sd' 14AIVk}eL_ 7R. .
W City I t 4NkSL& Q.,Q C.Q 4LV State NA C Zip Z$AS°
Projectho ation (County, State Road, Water Body,etc.)
Type of Project Activity - ,
PROJECT DESCRIPTION SKETCH ���. ' • (SCALE: I II_ .&0 ) )
Pier(dock) length O 0
ZOj ♦
Groin length
number
Bulkhead length
MoonNG piI,� ' •
1
max.distance offshore �'.I w"
Basin,channe}dimensions OA
r:',-0 x a.0 X—4
cubic yar
Boat ramp dimensions
Other ----FT
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S c t l.. $ O (_..
IVY v''a WR{E.cFtsV1C
ii.., s..., .....
\kVA
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- r
come null and void. f*-19
This permit must be on the project site and accessible to thb permit officer's signature
permit officer when the project is inspected for compliance.The applicant certifies by signing this permit that 1) this pro- 00 7/D_7 /f
0 d
ject is consistent with the local land use plan and all local issuing date 111 expir
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no ) (-4. 1 �Q
objections to the proposed work. attachments

DIVISION OF COASTAL, MANAGEMENT
• ADI&CENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVF,R FORM
Name Of Individual Applying For Permit: M Ia �..-k� / 1 T C\-1€ L (_
•
Address Of Property: \ 13 S 0,ft k C h Gwl v\
W2\ GI-A1SU LLE f3tA (N N.C . iS O
(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 toile 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 objections to what is being proposed please write the Division of Coastal
Management 127 North Cardinal Drive, 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
WAJVER SECTION
_ 1) vet n of ky, IS-t- , N S < PS ont
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift sandbags must be
set back a miiumum,distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setiaek,y,s,:u must initial the appropriate blank below.)
I do wish to waive the ' etback requirement.
I do not wish to waive the 15' setback req ment.
v 7-O.° (0- .
cam• f / �Si Signature) Date'
4/ZA� / OtU' ,i
momommum
Print Name
� AoZ a7<6 NCDENR
Telephone Number With Area Code NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES

•
DIVISION OF COASTAL,MANAGEI[ENT
ADJACENT RIPARIAN PROPERTY OWNER NQUIlfaaasifWAIVER FORM
Name Of Individual Applying For Permit: - M 1TC\i E L-L
Address Of Property: 3 �j o :+ Ll
P rty� 1 ` � '1 ti ti) >'\PL I 02,1 v E
r
(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 the 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 objections to what is being proposed, please write the Division of Coastal
Management, 127 North Cardinal Drive, 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
vec� �` � � � vT Q`f IS* / N S1rPS L11I
understand dial a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back1 mum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the s you must initial the appropriate blank below.)
I do wish to waive ' setback requirement.
I do not wish to waive the 15' setback requ nt.
AkIFICIVIA
- ---
Signature Da
_
Print Name
to Z -53 6,62 NCDENR
Telephone Number With Area Code NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES

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AOJP.C=�^r -r.iP .�Ta*T O1v G= CG� � N��7TC-N�?
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Name• Of 7:]diVlQllal Applying - Dr Permit:
(Lot Or str`n- 86
r, Strut or P.
•
T ad, City & County)
referenced
�-=__hereby certify ' that I
enc d prDDer- The individual au property adjacent to t, =
they ar-O L me as shown on the al applying for :1 c7pVa-
D_
should b` PrDDOSi- p da5`� ,e attached drawing the development
ev it ha=
DT-ovided with this 1 .s Dn or drawing, with
aaVal DDII►ar t
�� have noLT' 1 L!1 diIila*Zc;pn=,
objections to thic Proposal.
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u h=va obl �r�
Division e �i OP.s to -�
Vvi�sT:_�.. O1 COcst_l Mto what
is bcin❑ PrpDOsed .
won North Car ent . �27 Ca inzl Dlee wri c
�sVnoc�f on%N t of Caiolina28405 or Call c910- 3 D1VE r anion
da
OD C i pn i f notice. No r esco� a -3 00 -within
you have be=n notifiedsby Certified
red the cal0
_ i f i ed ,��-
- Mail
•
U r,y -__^_ of -nc-,`o nu=t be -- Di1;nc=, br==kw
na back a minimum �Le iJ
�D waive =� �C setback,
riparian access unless m diet- you
of wish
below. ) -D`Cx. VOL `cam waived by (If .
must initial lira
the aDDrODi=y� r�a7
______V: TLtrJ wl c1
to w= ive the _
-bc }i r.0 a
�- T Qo not ish _ L1r=?la 7t.
- to 'waive the 2.5 'setback reauiTement_
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Print N_-- ram__
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oni Number With Are � t
- - Code

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COASTAL EARTH WORKS, INC. 21.2 4
1955 Middle Sound Loop Rd M 66a172i2531
Wilmington, NC DATE ! - 1'
g PAY TO
g ORDER OFE 0 5 $ 50 E6
c4 �� �� 6ccu11Y IYiu ,
� — Y j� � "' ---- DOLLARS�o:I:3:o wok
COOPERATIVE
0
BANK
WILMINGTON,NC
FOR PST_, ` t t 8 2—P \ C" - --- --- m,
1: 253 L ? L ? MI: L6900 L030 211' 21 24 Gipi lgca)