60792D - Waddell

LAMA / E DREDGE & FILL ✓ NO. 607
iENERAL PERMIT Previous permit # Q
14ew ❑Modification ❑Complete Reissue DPartial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ R es attached.
Name f�. r� �1%t� I�If -� . Project Location: County
Street Address/ State oad/ Lot #(s)
State ZIP ZO I� ALROA
C i t'q<Skf — i jt ( ) _ ( Subdivision
;d Agent %� � n '/ �__ � l ry `j� City 1� I ZIP��
❑ CW }FZfW �CYTA ❑ ES ❑ PTS Phone # (� River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Ad nat
❑ PWS: ❑ FC: �` 1
Closest Maj� r. Body
des / PNA yes / Rio Crit.Hab. yes / �o A f ,,
Project/ Activity UYti` M
i
:k) length U
i(s)
.4i,
ngth
nber
J/ Riprap length__
distance offshore_
uc distance offshore
cannel
If
(Scale: I z,

� 0 lU � - "'(Af 4C I l q) -1-d , (-6 W
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATI LN FOR
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I S
I hereby certify that I own property adjacent to V`�I 'f'�
61 %A YV,', IM Da-) D.c W -f-t X1-41i, )4011-(Name of Property Owner)
property located at 1-23
(Address, Lot, Block, Road, etc.)
on 1 ri 1, in 3, x ( (-: � - 1) 1 N.C.
(Waterbody)
P%gent's Name #:
Agent's phone #:
(CitylTown and/or County)
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a sitt#rawing)
T"
Ax z3
W- " %$
tt you have to what Is being �ed,
ofu must notffy the Division of Coastal Managers '�ry
(DCM) in writing within 10 days of receipt of this notice. Contact information for OCM offices is
available at www.nccoastaimatWmentnetloontect dcm.htrn or by calling 1-888-4RCOAST, No
same as no objection ff you have been notified by Certified Mail.
1.Property Owner Information)
Rrf�wr Typ
Maifino Address
/- � IV -r T- L) 0 iz�
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address
--Z

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date IL .0 "
Name of Property Owner App ying for Permit:
Mailing Address:
�,)/v 114 f_I
�
I certify that I have authorized (agent) to act on m �7 y
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) )c
at (my property located at) Pj /'J zy h
i valid thru date ) , 11-
1 his certification s (date)
6
Property Owner Signature
Date

�2 IA. jj � t, Y b

1/29/2012 11:29 7038462830 EXXONMOBIL AM BSA
dover (1363*1NO)
PAGE 03
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to F Ilh 's
Name of property 7)
property located at _
(Address, Lvt, Bloc Road, etc.)
on y , in , N.C.
(Waterbody) (City/Town and/orCounty)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT
(lndMdual proposing development must fill in description below or attach a site drawing)
WAIVER SEC'T'iON
i understand that a pier, dock, mooring Pilings, breakwater, boathouse, lift, or groin must be set
rack 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 157 setback requirement.
(Property owner information) (Adjacent Property Owner Information).
'ignature .Signature
Print or Type Name Print or Type Marne
i

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ' KV 11 - tj�,P P
Address of Property: ?7
(Lot or Street #, street or Road, City & County)
Agent's Name #:-e�^ r', `��t r Malling Address:
Agent's phone0-523s-
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 pr osing. 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 Divislon of Coastal Management (DCM) In
writing within 10 days of receipt of this notice. Correspondence should be malted to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845, DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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.)
fi�i 11-�
I do wish to waive the 15' setback requirement.
1't ram
I do not wish to waive the 15' setback requirement.
(Property Owner Information) 7 r (Ad t Prope Owner Information)
S
i
gnature Sigtwlure it�u�rsov� �i^o+•s
/�Gi'11t yy�r�' t✓' ' �O f� l��, ! l Hop,
Print or Type Name Print or Type Name
Mifing Address Mailing Address
��.,- ,f-.,/I `% n f,+-I /?,/. /--✓/.o il., �17�

plicant: 0 (T t4 kVAV DES Permit #: t0
te: IZ_i(-'Z-
Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
litat Name DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
im act amount)
temp impacts)
amount)
± w Dredge ❑ Fill ❑ Both ❑ Other
f
Other ❑
Dredge ❑ Fill ❑ EBthD
Dredge ❑ Fill ❑ Other ❑
Dredge ❑ Fill ❑ Both
COMPLETE•
Dredge ❑ Fill ❑ Both
■ Complete items 1, 2, and 3. Also complete
• • •
A. Signature
item 4 if Restricted'Delivery is desired.
Dredge ❑ Fill ❑ Both ■ 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,
B. Received by (Printed Name)
CA
Dredge ❑ Fill ❑ Both or on the front if space permits.
1. Article Addressed to:
D. I deliv d' der
Dredge ❑ Fill ❑ Both
If YES, enter delivery address below:
Dredge ❑ Fill ❑ Both AK 2-611
Dredge ❑ Fill ❑ Both (," Y
2 S t` }
3
❑ Certified Mail ❑ Express Mail
Dredge ❑ Fill ❑ Both
❑ Registered ❑ Return Receipt for
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (F_xfra Fee)
Dredge ❑ Fill ❑ Both
2. Article Number
Dredge ❑ Fill ❑ Both rRansfer from service label) 7009 2250 0003 8170 9896
PS Form 3811,
February 2004 Domestic Return Receipt to
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑