17591D - Baker

s
CAMA AND DREDGE AND FILL o1 7m91-1
,(1) GENERAL
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 7 H •..)0oU
Applicant Name 1 E'7 74" d 3=�7/ "Xc'e Phone Number/9/D) 3il,`g ? (W)
Address en 6 5,441,/~ DR;Vt
City W.1rn j11i'rVN State /4' Zip oW'Yl -
Project Location (County, State Road, Water Body, etc.) $'?.1& )W't° rt/ hoe f,IF , ,¢hTAt-P- ' -7Z' G#1°A- 1=PW
k;v R 1 /ye*. t n'4NtA Co •
Type of Project Activity AbDiiS'a^' O c' r3c 4t L/4 T A"-0 Ji-C ' EJ ft 44irw 7U F'tilrii 46.
N o/hrh irt.tfy A;ex.
le- A// l'onfl7tivn1 ac 7,4 .J dO1 VA, AcieNy
PROJECT DESCRIPTION SKETCH (SCALE1'':-_-...7v / )
Pier(dock) length /1�\ eE j ,f U t-g Z�/
Groin length 1 'FT
• p����pasc` t�• x13 0number
Bulkhead length itiumt ",
0.
0 0
max.distance offshore IAy , P
qt K 1y
Basin,channel dimensions 0
0
cubic yards 0
0
Boat ramp dimensions
Other Ohm-LI ATT-1.)'Y131 .
t -1i640 cJ vSie M
Z:.--" '1../11.0 1 (3'( 43' 1'64
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any %� r�
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be applicant's signature
come null and void. ll
This permit must be on the project site and accessible to the dhl 46Fir permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro- tl1{.r/90/ 7l/,5191'
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
attachments ?/y .J0°v
objections to the proposed work.

• • GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: )&
ADDITIONAL NAMES: a-
AEC DESIG: PT �: kij DEVELOP AREA:_0.2 J PROJ DESC:
(Will only take 6) (Will only take 1)
WORK: Q i-
(Will only take 4)
MAINT:
(Will only take 4)
IMP: ©w a 2
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED:
CAMA MAJOR DEVEL REQUIRED: `I 11)I9 /0S l c

ill!'
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit: KZ.)\,,, .ARA -
Address Of Property: %1 L S.1�,f,, ;-,x, 0 .
.J 1\l/ r; -,,, Nc. -2-s{1 Z
(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.
--4-- 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 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.
Xs/ ��� 1 /,Ci �r// ( 4%*
Signatuie � te r� UCc'P � U X �sPrint Name , _ �.
I ) C2‘ 1 / �' eir-a.
r) I-I N R
Telephone Nu ber With Area Code

lir' •
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit: VeA, a- 120tka_
Address Of Property: ?fa)
(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.
t,-� 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 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.
Signature / Date ` •
411611-
Print Name ��,�,�
�� ' 3 c/22 EHNR
Telephone Number With Area Code

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Beth YounIr'en Bak ss 3o/53f
Baiter 357 1298
11 Keith Baker /11-8936 Shipwatch Dr. 910-791-9730 DATE_
Wilmington,NC 28412
PAY TO THE A�� � � —� d' V
ORDER OF ��/
00
_DOLLARS
Look for:Micro nature line,gray type and linetwrk.First Citizens Bank logo on back.If not present.do not cash.
HRsr CITIZENS 3.
BAFirst-Citizens Bank&Trust Company
�ii Wilmington,N.C.28412
FOR_
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