19769D - Rose

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eV CAMA AND DREDGE AND FILL
•! GENERAL
--Y 019769 --fl
PERMIT
as authorized by the State of North Carolina
0 Department of Environment, Health, and Natural Resources and the Cgastpl/Resopr.,e6C3mmission
in an area of environmental concern pursuant to 15A NCAC ��� art
Applicant Namel C�(v f P.D S P Phone Number
Address / .0 6 o�n{5 2 el f)r
City r- -( / �e State N C Zip 2 7 30 5
Project Location County, State RQad, Water Bod etc.)
IA? .Do/ 4: S-/ /ifl //{„ ge,t A .15A,ev4n- mAu C cU ✓� 1 /A LIc Jn5u,,l .r C• n t J
Type of Project Activity(c 1 S t C-+ /O ' X t7 1 / A eK cJ A�I��^ �� /6 ��41 i c � �
d I X !J3 ou'f' 1F' . AIplit"H f7 /fk ( TILC_ iveci 1),c , ✓fi ro,..� Sao--1-44 /<
h e Ai l am,-' 7 3 4/4« c �. 0 -/- cit /i I'CJ( SC' - . 6,,, l-
PROJECT DESCRIPTION SKETCH (SCALE: II)o+ 7- $( /r)
Pier(dock) length w
Groin length /?' p -
1"
number /�/ �oc+ 11
Bulkhead length
max.distance offshore D 0
1O ' .71
Basin,channel dimensions
cubic yards '
Boat ramp dimensions
5 0 '
Other '..-7 1
i
D41;^
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any 4 . _
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be f4,,t,1„
applicant's signature
come null and void.
This permit must be on the project site and accessible to the 0 - (?coi-- .)permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro- a - y ' q , g1 I G
- q 9
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no r) /4 . l a 3
objections to the proposed work. attachments
- A ' 1) . . -... a

—�� _:-zuili — L.:ut1:u'1's:R FORM
. FIELD REP: 1)Ct.
r-- -e (— _.. l�
'Di q APP FEE: > . -
PERMIT' NO: r)k 'I - COUNTY: �Z—•, ►'t_
AEC L) 'SIG: V(, fs;
E liti WATER BODY: 1 f L(IVk—/11.ct t i C4 mt.4 J
•
APPLICANT NAME: (� r-1 ,‹ . 1) c) S("
ADDITIONAL NAKE(S) : _. - -
MAILING ADDRESS: -/ C7 4_ `• •Xe,n t4 0 " , PHONE:
'-: CITY: � t("f"eu i f • - �., . - ..
PRO . " �';_ k . / - STA E. ZIP: Sat
PROJECT LOCATION: l a• �' / .him'... �+
TIMLUDING CITY Oil LOc7LITY WHEN DIFFERENT FROM MAILING ADDRESS)
DEV AREA: _ .©- 1_IS PROJECT DESC: LAT (X : LONG Y
WOR L _ JL _) (Fs: -- --
CODE LENGTH WIDTH DEPTH . CODE • LENGTH WIDTH DEPTH
• Cr.DW LENGTH WIDTH DEPTH CODE LENGTH .• WIDTH DEPTH
CODE SQUARE FEET •)' CODE SQUARE FEET )
CODE SQUARE FEET
• ACTION =_EXPIRATION
DREDGE AND FILL REQUIRED: ` . k'-41- " I ' �J' -�;_e 1
COMA MATOR DEVELO- ow REQUIRED: .
- - CODES POE AEC DESIGNATIONS ="OH" — Ocean Hazard - "CW"- - Coastal Wetlands
_"EW' .-- Estuarine Waters "FC" Fragile:.Coastal. Natural/Cultural
"ES" Estuarine Shoreline "PW": -. Public Water' Supply"PT" -_Public Trust - •"OR"
Outstanding Resource Water
- . CODES FOR PROJECT-
"Pr `r vr;te, tzsially an individual "F" Federal"C" f'cmmercial " n
L Local- Gavernnent
"U" Utility "H" sousing Development
"S n State_ - -- _ "0" Other --
- - CODES FOR DESCRIPTION • _ _ - -
-"11" Bulkheads,-.Riprap - ,"15n:Utility_Lines
"12" Piers, Docks, . Boathouses - -'"17,n Emergency: Repairs.
"13" Boat Ramps - - - "18" Beach g
-"14" Wooden Groins, __ - Bulldozing •-
"15" 7 aintenence• of Basins, Channels, Ditch•es "19"- Temporary Structures

pIVYSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit: :A6 N(. F-0
Address Of Property: I2fl Q L..Pt-ie..t Q12-i'I
Houm34 e5 �-1, tilt Zs 411 13124-Irt to-GO.
• (Lot or Street I, 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.
'` V I have/no objections to this prop sal.
(-;14076,05rOk) /OA- 4.4d 0
•
If you have objections to what is being proposed, please write the
Division of Coastal Marem-e_nt_. 127 Cardinal Drive Extension,
Wilm'Lnaton, North Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response' is considered the same
as no obiectionif you have been notified by Certified Mai).
WA11/Ex SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift 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 rust initial the appropriate blank
• below.)
II do wish to waive the 15'setback requirement.
,�� rE uir
r -
I do not wish to waive the 15'setback requirement.
•
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Print Na�mel i��CliCPPV
�� �r..��
C((7> %� - /�7/z DEE E---I Imo!F
Tel phone Number With Area Code

pIVYSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit: 6eG1--= tI
Address Of Property: 1 9?--'`tom
l�l�D�hl SO'Ck rl& 20<4s1 tit45W t!.K-Gc•
• (Lot or Street 1, 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.
'` 1 I have no objections to this proposal.
CBUt-K t o t41-X)
If you have objections to what is beina eronosed, tleaee write the
pivision of Coastal ManAssement. 127 Cardinal Drive Extension,
Wilrninaton. North Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No resuonse• is considered the same
as no ob-iection if you have been notified by Certified Mail
. W'A1VEm SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift 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 rust initial the appropriate blank
• below.)
I do wish to waive the 1S'setback requirement.
I 110 not wish to waive the 15'setback requirement.
•
•
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Prins-,LaeVQ 79 6 Mo
Telephone Number With Area Code •

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