89650A-Russell

o'Acomr"'�❑CAMA [I 'DREDGE & FILL NU 89650 A, B C D
4. GENERAL PERMIT Previous permit
t Date previous permit issued
❑New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC `! ( - ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name ! Authorized Agent h A\ f'\
Address - Project Location (County): ( i i
city+ ! , �.i State ZIP ' - Street Address/State Road/Lot #(s)
Phone#('._;.)
Email Subdivision
City
Affected ❑ CW ❑ EW ❑PTA ❑ ES � pT5 Adj. Wtr. Body C_ 1.1: f f i { t + r - II<' (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body k l- h 1 1i"
ORW: yes/no PNA: yes/no
Type of Project/ Activity
ChnruHi Ion h
I
(Scale:N 7- 7 )
!.
.
i
.,
-(+L
-
-
Access Length
_
Pier (dock) length-
-
_
FixedPlatform(s)
I
r
!
!
!
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/Riprap length
w
Avg distance offshore
Breakwater/Sill
Maxdistance/length -
Basin, channel
Cubicyards
- -----
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
t":
,4
`
: •`
1
.6-
_
Other
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SAV observed: yes no -
-
Moratorium: n/a yes no
,
Site Photos: yes no iwt-ply
Riparian Waiver Attached: yes no'.
_..
..i
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature -'Please read compliance statement on back of permit"
Signature
Feels) Check q/Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT)
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Adjacent Ripanan Property Owner
leN.:hc oaf,
Address
M\ - A i r•I WE'D o^i 1071 �
City, State Zip
To Whom It May Concern:
-y�a3
Date
Cz k r\ 010 t✓k nc-
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to
on my property at 1?.no o\ LJ u. r r r V t\V Z A %. n a e e C•
in C.,� f r; k4e k— County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
(LOCAL PERMIT OFFICER, NAME OF LOCAL GOVERNMENT, MAILING ADDRESS CITY, STATE, ZIP CODE)
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact (LOCAL PERMIT OFFICER) at (PHONE NUMBER), or by email at: (LPO EMAIL).
Sincerely,
-701yv%Y-^%A -P, u sr,\
Property Owner's Name
ft.r.-r
Address
City
Telephone Number
State
I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
-Jm
w4n� —
Adjacent Rilfarian Signature
�nsce.5'� ��o�W�cgln
Print or Type Name
31q(aDa3
Date
Telephone Number
Zip
Address City State Zip
Revised July 2021

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpie4e,..
or on the front if space permits.
1. Article Addressed to:
`Davis 'Pll�1dl
6 ri G reen Mec,j%tJ
'��CA 1ii2n 0.23060C`rC�t
' IIIIIIIIIIIIII'llllllllllllllllllllllll�IIIIII
9590 9402 6361 0296 8639 50
9. AdialA Numhar rrrarnsfar from servos label)
7028 3330`0001 7644 6183
PS Form 3811, July 2020 PSN 7530-02-000-9053
X V a(� �,,, „,� / D ❑ Agent
(/U ��JY yv�/`�J ❑ Addre
B. Received by (Printed Name) C. Date of Deli
D. Is delivery address different from Item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Pdanty Mall Express®
❑ Adult Signature
❑ Registered Mail -
El Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑Certified Mail®
Delivery
❑ Certified Mail Restricted Delivery
❑ Signature Confirmation^"
❑ Collect on Delivery
❑ Signature Confirmation
❑ Collect on Delivery Restricted Delivery
Restricted Delivery
1 Insured Mall
I Insured Mail Restricted Delivery
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Domestic Return Receipt
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