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CAMA AND DREDGE AND FILL
1, GENERAL 019791— D
-......) PERMIT
as authorized by the State of North Carolina
/�/� Department of Environment, Health, and Natural Resources and the Coastay Fees ou{c�s Commission
in an area of environmental concern pursuant to 15A NCAC
�/f-� A. �?J
Applicant Na �G r 1 Pck r F _ PhoJ�a Number
Address ( ( r✓n f ii 1� e r r 1 —''. V ihscit'
City 4 1 i 60 r st &• Zip 4 3 /
Projec ocation (County, State Road, Water Body,etc.) ; A^ t" ti S • /'/1 0 CP4r S(/
� u�� Murt � lMca � f j/ r• a4Skri1. k crJv 4-1
Typ oject Activi y 4r� "f 6 S 47T3 4 f 4� at-k 7'/x I / ' g4./.A v\ aOC/ k
--e.1 i tin IJ es , /i r,,n S 7f/v C /.• 4 5 h 4 �I hP e1 4.- /•{ti.1I 1A .J/i-1-1-"
f 51 aC OA Pu(�4 r 'gar,un ( or ricar' .d- SDI<rl A. C<ed I/_1 - e widik a,t"C/�f W4 Pi
bA , Ail ( 54 cii )1'. a� ?,14• l a� SA 'I 47pip "
PROJECT DESCRIPTION SKETCH (SCALE: /,j ., c (f )
Pier(dock) length
N
Groin length -- -------2.,
C../ (,(n At, cA e r _I, I',Gl
1 (2____--,
number
Bulkhead length /y'
Iq ,
max.distance offshore _►-
Basin,channel dimensions i -'
4
6'
cubic yards {�
Boat ramp dimensions \ "5 0 /
Other Cur D f Is
/ 7 5 w,/fr.,r1 4 o n
ocPt.4 -I Ts 7C 8c1.)
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- \_/
come null and void. 9_ ,, �,j ��,
This permit must be on the project site and accessible to the �/l permit officer's signature
permit officer when the project is inspected for compliance. J _ l / �A _ /, 4
The applicant certifies by signing this permit that 1) this pro-
ject �C v' �//
is consistent with the local land use plan and all local issuing ate expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no 'J /I - la o J
objections to the proposed work. attachments
. . L_OCC )

GENERAL PERMIT - COMPUTER FORM
FIELD REP: 'P4 r--ke, APP FEE:
Y - -.• (]. ��
PERMIT,NO: n !Gi q 1-. /13 _ COUNTY: J r ...A.S &,
AEC ICE SIG: • p I F W WATER BODY: "Na n-'K 1, --( - CJ 1
R /act
•
ADDITION NAME(S) : _ : -. • . . - - _
•MAILING •ADDRES • • D' r,-- f--:. . :: •
l ` -
�• c�•y�� PHONE: _
_• CITY: • i • :..b,2 `"'0 .• . •
- .. .- STATE ZIP: � � 3:/ ,�
PROJECT LOCATION: - .• . _
INCLUDING CITY oa LOCALITY _ (WHEN DIFFERENT FROM MAILING ADDRESS)
DEV AREA: n`D 3PROJECT DESC: = t ) • .
I LAT X : - LONG (Y)
WO �,'i 6 o i r
y _ _
ODE LENGTH WIDTH :- DEPTH CODE LENGTH ; WIDTH -` DEPTH_
I. MT: ( :_ _ _) ( 1 =
col)E LENGTH WIDTH DEPTH CODE LENGTH WIDTH -- DEPTH )
- CODE SQUARE FEET CODE SQUARE FEET 2 CODE SQUARE FEET /
•ACTION EXPIRATION
DREDGE AND FILL REQUIRED: - .` '`v1`- j.'`,z
LAMA MATOR DEVELOPMENT REQUIRED:
* ************************ *************************************************4
--: CODES_ FOR AEC DESIGNATIONS -
:"OH" -__Ocean Hazard `- - n "=_ -_
CW Coastal Wetlands
"EW" -- Estuarine Waters _ "PC" : Fragile`Coastal Natural/Cultural
"ES" Estuarine Shoreline •
„PW. Public Water Supply _
"PT" .a_Public`Trust :"OR" =_ Outstanding_.Resource Water',-
CODES FOR PROJECT- _
"PT' 1.-ivcte, •isually an individual -=
"F" Federal
"c" Ctil tyial -:"L Local Government
"S" State = - - H Housing Development -
- . "On. Other - -
CODES FOR. DESCRIPTION - -
• J
•�' n Bulkheads : . _ _ _; _.
it ,_ pi rap -> ' = z "16!'
- �IItility_.Lines
"12"_ Piers, Docks,`.B oathouses '- - "17"_ Fier en
1113" Boat Ramps = _- _ "18". Repairs =
g cY
"14" Wooden Groins: - -_ - Beach Bulldozing
-"14" Wo a • • ' _"19", Temporary_ Structures: -
intenance"of Basins, Channels, Ditches - . -•.

;; SENDER:
3 ■Complete items 1 and/or 2 for additional services. I also wish to receive the
i *Complete items 3,4a,and 4b. following services(for an
n •Print your name and address on the reverse of this form so that we can return this extra fee):
card to you.
s •Attach this form to the front of the mailpiece,or on the back if space does not f. ❑ Addressee's Address •
u permit. A•
P. ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. El Restricted Delivery t
•The Return Receipt will show to whom the article was delivered and the date
- delivered. Consult postmaster for fee.
5
3.Article Addressed to: 4a.Article Number
II i Vm� k itk-��r\c N( `� yet � `�- 5,
_ � 4b.Service Type
i (p' ' 1'a—a�'m e c,� `,J F r ❑ Registered p Certified t
tq (b22 (, ❑ Express Mail ❑ Insured
1 O'Retum Receipt for Merchandise ❑ COD
f 7. Date of Delivery
i 5. Received By: (Print Name) 8.Addressee's Address(Only if requested
; and fee is paid) J
I.
i 6.Signature: (Addressee rAgent) f�
0141-GL 1 '1 (Lk IJ�-
oe c.,r..,gal nonorrihnr 100A flnmactir Rate irn Raraint

^
_ »r
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
� Y�' \ x '
Name of Individual Applying For Permit: ��_'_ �-[��� �_ ���}
Address of Property: {��� \�_} � _..............
__
(Lot or Street #, Street or xoad, 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 drawi�g, with dimensions, should be
id d itI. this letter.
`
I have no objectives to this proposal .
� -
If you have objections to what is being proposed, please write the
Division of Coastal Management, 127 Cardinal Drive Extension,
Wilmington, NC 28405 or call 918-395-3900. 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 sat back a minimum distance of 15`
from my area of riparian access unless waived by me. ( If you wish to
waive the etback , 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.
__ ...__.....................................................................................................___________________.......................
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Print Name /'
_..................................__ ............................
/ elephone Number with Area Code

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CRICE .
PH. s10 sus-oONSTRUCTIO►� • a ;ti --...- •
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6618 BEACH DR SW
- _ . -_
OCEAN ISLE BEACH NC ""
284694710 655.�
HE
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OF G
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4 DATE 66-112/531
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LEAN ISLE gEAC1 N 28488AD n V
DOLLARS Cr
1110000855
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