20027D - Autry

1 CAMA AND DREDGE AND FILL
GENERAL Ni.' 02O1 27
,c ...) PERMIT
as authorized by the State of North Carolina
10 Department of Environment, Health,and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC MIA •12-00
Applicant Name qiIC J S 1 ` '\U-k'r Phone Number 1 ID 3�U— 1 2 -
Address 4c ^14"kk � e-
City U f f C % State kiL Zip o?ay 4 LC
�h ce+
Project Location (County, State Road, Water Body a c.)
tuf r C %4--� , tJ t . pm- M r & r R 1
Type of Project Activity NI '(.tA) t.AnCOV-r er'1 loA* r' F+
% b()Ak v c'+ must Cotes 1,,‘ W', e- V/4 c lic — ci nro+ e-kccec! Y4 d'ls-f-n^c'e
across -H.e_ cf,NAt bvaIK rJ -b bvt1t:t-,&(\c( - V'c'nsurc 4-o corsts dksfo-nc° ,
PROJECT DESCRIPTION SKETCH (SCALE: k)OT Tu )
Pier(dock) length
Groin length
number
Bulkhead length id
0 Uncovered 9n
max.distance offshore r c t IOf
• OS,
Basin,channel dimensions
cubic yards Q._
j Ex\s-k i nCi 11
Boat ramp dimensions ---i:C
iJUC.-k )° 6
Other— tO 1 Nil.. 10 I 'S C
f
pL .. - : Ili f Th
This permit is subject to compliance with this application, site 1
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be plicant's signa ure
come null and void. 4 ,,,,„ ,
This permit must be on the project site and accessible to the permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro- & c91 1 9cl �J1 •t cD7 j 1�CI9
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 /41 • I2 ap
objections to the proposed work. attachments
- - -- --- tb .1,

GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: G k 5 Tr
ADDITIONAL NAMES:
AEC DESIG: P T t i- J DEVELOP AREA: .002-PROJ DESC: p - ) 2
(W�i l only take 6) —— —
(WM only take 1)
WORK: b L lb' /0'
(Will only take 4)
MAINT:
\*C‘915'
(Will only take 4)
IMP: O tAJ I 0 U
(will only take 6)
ACTION EX?IRATION
DREDGE&FILL REQUIRED: "T / cal I cl / 7 a7 19
CAMA MAJOR DEVEL REQUIRED:

' QIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER_ FORM
Name Of Individual Applying For Permit: CietJ; fj4iitr/Address Of
Property: �(�� 9 C�� �f-'
S w f Ai. C ' Zk>15,.
(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.
Xt/ I have no objections to this proposal.
If you have objections to what is beina 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 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. )
X I do wish to waive the 15 'setback requirement.
I do not wish to waive the 15'setback requirement.
611- 14----L
"- � � _ yy
I
nature Date147:7A
f�/Y/es P',ft e/f' _Print Name .�
,3 6 - 9�- - o .9 8� U F H R Telephone Number With Area Code

•
� Personal
Nah'onsBank® Money Order No. 02 2521
NS t a :,.; i. i (�,. ( , t ! ° :r '✓ { ;;{ ;zsl< ..�. 11,. 0It };;� l jill, tf ! llitt tiii rtl .'1
E{i! ,-ru if iii �"1.41riy N 1#E ,-li i %m '''ili i � ..1.1€ E{$K, 4, . t.„0M,,,: 1�t t ak t , 4 ,,,, ,`'!€ "�t , .,, '- . ai ,
4 ���h ���.� �,'! A�� "�!• �.��� S' •
,\'y .n� \ �'^ \j.x\ ;'k \i'b:d:'� q ? i f tlf %.51}}. �' ) .�i ll>. t �. ; 'f' t.
3,' r. 'k,,, 'Il `: ' 'A €� "Y.i .y3� k:,;,s : ilir {E tt, :.3 I .;':tt$ i i! '11;3 3 tst l lii I'l> .3s tl
tl!( ,#�4'3 1/.l{ ii } !t3 1 t (lit .,Jljt ' ��!'& t= In qj�l,,t :f k t } 1 }#, sofa ., flft ` /� �y
•�3iSf !!!�; .e�t�� ?L]� ��' i ��� {t �� tt ��Ft��1.���T t "# � i�t �} .;t �� �1T` 4
i
Pay To'Thoglj . S #aF+F�F###+E`if k Of t*iF
Order Of
*#* #**�k*�F?F**#* * F?�Y•R*iF?E?k###- ****##****•A-*•1F•#####R *4. *3f*?E!F* #**#********t*##dF::3t
NotValirl •1if#•k+'t4FlE!F1F#-lE•14•IF-IF•lE9E•?f•lf' #•1f3f4lt*k'!#74!+t-1�•1F�tiF?F143E•lF:i?FaF1F#iF#lf1F##liltlt34a4•iP?I•lF3F-lf!!•1F#+t•lf•1E•1(•!F•IFiE•.**1FlFiFit
If over FIFTY AND of!100 Dollars
El,l)00.00 -XiFs# +f# #+F* 1FiE-*3F -M*3F�43FYr+f**A-X--?F*i{I *** -?F****•*3t+E**3F-***—*-lE)E•3f+F+Fk•**id3F •**. *.*********
For ,
02 101+30 99 i`Y‘ O~—'" —
NntionvlS;urk is 1101 h able f f 10,1 or tf I n tnoury<r W.ts igruitUre b dare aser(UrBWCr)
fli40t -tu�rrotect n.t f•finn,t 1 s..,of iholl.°i,n;Andrntnplelr Ihrg 111,,w,Urdt 7 1l,so I a,{oa 1.111e gq 'L �1 b
I N•ittonBnttkof Texas.N.A Address z /r
ISati tit,uti,f lexnau .b:. v 7
n'023252Ln' 1: LL40000L91: L64L00056LH' C--1 �� p�
— - _i N;A'FI'G�L IQ'iAIE',Y1l, CN Eg-TJ h,H;EGKINCiE;TIHE$'EJf DORSEMENT.
TiI�E�ORI,GINA'LOCUMEtJI'�}!'�A�S}A�R-EFI.E�TI,Vey'A-W'�aERh1A�IC�ON�;TiHE�BACK ;;<'? ® "® A+T
Y ,4 }
C
i