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- �CAMA AND DREDGE AND FILL
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GENERAL - ` 0176491
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC -7 . ) 0 U
Applicant Name S 0'0 hone Number °I 1 tJ e4-29j LI LIq S'
Address C(aO V C 1.10o�1 L Prt-2
City r j l �.T'�,, `'L State Ni ( - Zip ZS 3 I 1
Project Zion (County, State Load, Wat Body, etc.)
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Type of Project Activity ' - r
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PROJECT DESCRIPTION SKETCH
—DPI vl s CCANCAL.,- (SCALE: - 301
Pier(dock) length ±—.,_--4.-. 1 i t _ L . 1,..-..- t {- { . —
t i r' 1 a ' f # —1 It
} f '
Groin length .._.W.r... ! _A.
1 "
number
Bulkhead length � } t
r i — - -�- 1
±. ,- *-1,-tr- 1 t
max.distance offshore I
l< '� _—r-.r...T t
Basin,channel dimensions �. i
,
_.. . 1
i H - i----1'
cubic yards i I 1
—±
_ T—
Boat ramp dimensions I , 1
Other ''' ? i - 1 w..,
rural- 11/x la'' --- -,-- - -t -4. It
PLAITorpv\ 144 2, , :r_t
►2A -r�a� l '
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This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any , - 7 L--'
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. 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 ` �-�J-CI?) —7`' .2-0-9 5_
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 `^"j ',1 1 100
objections to the proposed work. attachments I
II_

GENERAL 'PERMIT1 COMPUTER FORM
APPLICANT NAME: apDy, IJSI-��, 6cr-
ADDITIONAL NAMES:
AEC DESIG: DEVELOP AREA: . 1 _ PROJ DESC: P -
(Will only take 6) (Will only take I)
WORK: TE
(Will only take 4)
S I` 1 1
-Ly-0
MAINT:
(Will only take 4)
IMP: 003 24°
(will only take 6)
ACTION EXPIRATION
DREDGE&FILL REQUIRED:
CAMA MAJOR DEVEL REQUIRED: Lt - .1 a v-s)

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER_ FORM
Name Of Individual Applying For Permit: felipi c,s a, aSfa n�orf _
Address Of Property: /24 g. l SL4'n,Z ,fir•
Loh Qe4c 4 d/,G , ad rums cv%61t Coun t7
(Lot or' Stree '#, 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. 1. description or Cra;,i; , with tiilu nsions,
• should be provided with this letter.
X I have no objections to this proposal.
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If you have objections to what is beina proposed , please write the
Division of Coastal Manaaement , 127 Cardinal Drive Extension ,
Wilininaton ; - 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 distanceof
from my area of riparian access unless waived byme. i5
to waive the setback, (If you wish
you must initial the appropriate blank
below. )
I do wish to waive the 15 'setback requirement.
•
X I do not wish to waive the 15 'setback requirement.
•
X is i' � J d - 4"
Signature Ltih � Date
17.e,n4 . /7Af2ui5eN ' • •
Print Name
H R
Telephone Number With Area Code

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`' SENDER: I also wish.•to eive U%4 _
v _•Complete items 1 and/or 2 for additional services. following sery s r ar12`
N •Complete items 3,4a,and 4b.
w •Print your name and address on the reverse of this form so that we can return this extra fee): \ ;9
card to you.
> ■Attach this form to the tront of the mailpiece,or on the back if space does not 1.❑ Addressees •
'- permit. 2.CI Restricted Deli
■Write"Return Receipt Requested"on the mailpiece below the article number. very 1
Y ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fbe.
0 3.Article Addressed to: 4a.Article Number
GI )� n n e fti I�Rr�41f r i O -/ � b Z-Y
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a. q G 4b.Service Type �/
o �- 3 C©� i o(S �� ❑ Registered E Certified 1
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to G) r L q, e s f m) cc. ❑ Express Mail ❑ Insured
w riiCg- S Keleturn Receipt for Merchandise ❑ COD
o N ,? 7. Datof Delivery •
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cc 5. Received sy: (Print Name) 8.Addressee's Address (Only if requested
D and fee is paid)
cc 6}1‘i 'e:01'diresR,2,400:7:7-1/4____,
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N PS Form 3811, December 1994 102595-98-B-0229 Domestic Return Receipt

a SENDER: * --I also wish to receive the ,
D •Complete items 1 and/or 2 for additional services. following services.(for an
w •Complete items 3,4a,and 4b.
y ■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you.
w• •Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address •
w permit.
•Write"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery t
d •The Return Receipt will show to whom the article was delivered and the date
delivered. Consult postmaster for fee.
0 3.Article Addressed to: 4a.Article Number /
d iY)Ar3 ," i' mcGArth7 2 VL� `Z- � � 7 1
a 703 '. Z 8 ).4 5 -. 4b.Service Type
£ ❑ Registered [IFtertified 1
° Lu,1ber)`'oi7, /VG „
U
CI Express Mail CI Insured
w 2 3sieturn Receipt for Merchandise Cl COD
O 7. Date of Delivery
/c r/
x 5. Received By: (Print Name) 8.Ad ress e`s Address(Only if requested •
and fee is paid)
6. Signature: (Addressee orAg
o r `��� � �CC��
2• PS Form 3811,Deceniar 1994 .•:2,"

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?,..... ® Security enhanced document. See hock for details.®I
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I s COASTAL DOCKORKS 183 W
f P.O.BOX 10671
SOUTHPORT, NC 28461
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1.i DATE 4 - 2 0 —f O 66-305:
PAY D e !V /e
ji ORDER OF ,(`'
: I $ S © , o0
_h �� ��7 t(/OGLOi S d- ti�.c,
6` DOLLARS Bum
FIRST CITIZENS 453
, BANK FirslCitizons Bank a Trutt con p,,y
Southport,N.C.28465
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FOR OS fGe) QS`,-F
I' °'000 L8 30 1:0 5 3 LOD 3001:004 5 3 2 o 6 76n•
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