61653D - Sides

❑CAMA /4Y❑ DREDGE & FILL NU 61
GENERAL PERMIT Previous permit#
.New __Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued --t
Drized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Z
!� / ❑ Rules attached.
ntName unNA d-E-S Project Location: County
s a`7 [9 (Z F—pi i tl�c Street Address/ State Road/ Lot #(s)
1NSJ utA - S AL,& M State NY-, ZIP --T IZ=-:} C--"c, p vs64..,
It ) 4 ia�. � ��' Z � Fax # ( ) Subdivision 6 1'o-- �1^
zed Agent I n riff j Aet V,A-9 l.ONS� Ciry N 0✓1 1n I Cr ZIP
❑ CW , EW ti PTA ❑ ES ❑ PTS Phone # River Basin rF &
ElOEA ❑ HHF =' IH ❑ UBA ElC N/A Adj. Wtr. Body o nat
❑ PWS: ❑ FC: Q SiresQL
yes / no PNA �/ no Crit.Hab. yes / Closest Maj. Wtr. Body
)f Project/ Activity
ocO length D X f rJ In
m(s) 12 1 X 1 (b
pier(s)
ength
umber
ad/ Riprap length
✓g distance offshore
iax distance offshore
:hannel
jbic yards
imp
use/ Boatlift
Bulldozing
ne Length.
not sure yes 19
gs: not sure yes
rum: n/a yes no
yes
Attached: yes
ling permit may be requirec
✓✓V
(Scale:

)plicant: N Vi l CI Q
Permit #:
ate: 1 _ _ 13
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
�itat Name DISTURB TYPE Disturbance total
Choose One includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet FINAL Feet
(Applied for. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
Dredge ❑ Fill ❑ Both ❑ Other ' 9 Z�
f ��
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

2297
Bank of America.
i�iTRUCTION, INC. ACHwross000tse
IETT LANE 66-19-530
RY, NC 28460 t
w
0
1297110 i:053000L96': 2370L533771,811'

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date l ?-,o i
3.
Name of Property Owner Applying for Permit:
-3-0 h V, wu '%�,dTs
Mailing Address:
I certify that I have authorized (agent) -h*- i r)eCom G t act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) 2 01 A
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner_-,
Address of Property:
(Lot or Street #,
Applicant phone #: ' t u Ja —1 3���_---_
Jr Road, City & County)
61JhY)oi2A (A(lSf,
Mailing Address: 03�501 F_-nnyPAtU/ -
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, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact-dcm.htm or by calling 1-888-4RCOAST. 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, boathouse, or 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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Y(Property Owner nfor ation)
Sig ture/
14 A
rint or Type Nge
Mailing Address
(Ripari�Pr�opert Owner Information)
Sig re
X� +- - -_
Print or Type Name
%�-V0 bQx 2a2L1
" Mailing Address

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
PO xY+ -+ ann%, 9hcrt4-
3DI FAIct-v I<<e, 'q
Or- 1/011t(Ik nyc QTcQoc
A. Si lure
X �
B. Received by (Printed Name) C.
D. Is delivery address different from item 1 ?0
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee).. ; '❑ Yes
2. Article Number �,/ `
(Transfer from service label) 7 011 3500 0001 3 9 5 6, 4 5�
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
■ 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
(Ylf.�ohn Na�m�
PO BuX aciay
Sat- clfiy Ksc, a&uL45
A. Signature
❑ Agent
❑ Addressee
B. Received by (Pri'n eeh Name) C. Date of Delivery
D. Is delivery address different from item 1? ' ❑ Ye:
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
2. Article Number
4. Restricted Delivery? (Extra Fee) ❑ Yes