20049D - Scrivner

CAMA AND DREDGE AND FILL
�• GENERAL NC. 030049-3
PERMIT
as authorized by the State of North Carolina
0 Department of Environment, Health,and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC '1 i-) • t Z OU
net S-r%\1ne-,r- Phone Number 9U) 328 . 6 L:c
AApplicantddress Name o . -Roy, 3
City Sit;1*_M bur State C J Zip 8 3&5
Project Location (County,• State Road,Water Bo y, etc.)__L n S(O u i (t7 t l-n'�'t.� 1 C Ck V)A t tI C
-rem+ 1 No c Jein T�P s f�t 1 3 c I , &)d) �-k-u t-,? So u n Ci
Type of Project Activity NeniJ Pteir' Prnc� d or (C.-
PROJECT DESCRIPTIONj SKETCH i •`',, ( f_ (SCALE: NOT TO )
Pier(dock) length v I if i 1�/ Iry �Y�/
x 4' uw°de.� ' v V
Groin length
number
Bulkhead length
max.distance offshore
Basin,channel dimensions (�I
�1
KY
cubic yards 11 V
Boat ramp dimensions �/V r r \� 4/ (OVI t `V' 1�,l� v / 'I/ \ w 7
Other R D )(• ( -0 1
�,xP� �oc� •
,50, LOT
. i
if, a �.A � P t L f\C �* ,
3�
`
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
violation of these terms maysubject thepermittee to a fine, �rie,2./..0-L...--- -.----
applicant's signature
imprisonment or civil action; and may cause the permit to be-
come null and void.
This permit must be on the project site and accessible to the permit o ficer's signature
permit officer when the project is inspected for compliance.The applicant certifies by signing this permit that 1) this pr `() 19q i_ . 10 , I q 9
ject is consistent with the local land use plan and all I cal issuing date exiiration date
ordinances, and 2) a written statement has been obtained fry
adjacent riparian landowners certifying that they have no 14A . V2.00
objections to the proposed work. attachments

r U 1 R FORM
_:,ppLI CANT?�_M : To. PmA Vhr—j
ADDITIONAL NA.I ES:
AEC DESIG: P T DEVELOP AREA: OO_i. PROJ DES C: P_ 2_
(Wil)only take 6)
(Will only take I)
WORK: P L`x g' T E. t o yC 1 Co'
only take 4)
MAINT:
(Will only ukr 4)
IMP: (._N\ 3 2 t3 td3 l C9 0
(.Wonly take6)
ACTION EY2FRATION
DREDGE&FILL REQUM-D: • �Q j (o t l cl 9 itoton
C_4MA MAJOR DENTE,REQUIRED:

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: N vi d Dana (incr.
Address Of Property: a 3 9 MAke,pPfiCE �7--
WDrTh ropsa I e ch ' i marls/DLL/
(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 me 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 Cardinal Drive Extension,
Wilminaton, North Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no ob-ection 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. )
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback reouirement .
ge/4- .
Signature / Date
/-1 , WALKEN E Z , 6e ec
Print Name
1i i- 732 - 4. -3/7
Telephone Number With Area Code

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: NN - 'Uana S crivper
Address Of Property: ....)39
- p sa, I �C. Oils/o w
(Lot or Street #, Street or {load, City & County)
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.
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
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. )
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15'setback requirement .
71. 71A- 27, y�
Signature Date
p.j, Dti/H-/5
Print Name
2- 7 If (1 * �' G
Telephone Number With Area Code

ai SENDER: I also wish to receive the
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' rn ■CoCompletemplete itemsitems 31,aaand,andor ab.foradditional services.
following services(for an
ao ■Print your name and address on the reverse of this form so that we can return this extra fee):
.y card to you. a
+ ■Attach this form to the front of the mailpiece,or on the back if space does not 1.I:] Addressee's Address 2
d permit.
d ■Write'Return Receipt Requested'on the mailpiece below the article number. 2.El Restricted Delivery N
■The Return Receipt will show to whom the article was delivered and the date
delivered. Consult postmaster for fee. _o,
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H PS Form 3611,December 1994 102595-98-B-0229 Domestic Return Receipt
v SENDER:
•Complete items 1 and/or 2 for additional services. I also wish to receive the
rn •Complete items 3,4a,and 4b. following services(for an
a) •Print your name and address on the reverse of this form so that we can return this extra fee):
F2 card to you.
d •Attach this form to the front of the mailpiece,or on the back if space does not 1.0 Addressee's Address U
d
` permit.
2 ■Write'Return Receipt Requested-on the mailpiece below the article number. 2.0 Restricted Delivery
■The Return Receipt will show to whom the article was delivered and the datecii
delivered. Consult postmaster for fee. o,
` 3.Article Addressed to: 4a.Article Number IA St
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urn Receipt

•
•
RUTH M. SCRIVNER • 10.
• D. D. SCRIVNER 9 66-7704/2531 ��
P 0 BOX 38 PH. 910-564-4379
1362 CRUMPLER MILL RD DATE
SALEMBURG, NC 28385
• 7 I $ 6;0V
FAY EE 40&-LV NI
' URD R OF
DOLLARS©o«:°: e....
M — II
rI Stat E> ployees' Credit Union oI
Clinton.North Carolina ail
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�: 253L770491:0860 544 2 20 311' 4i8 C1P9-CO" q
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