63936_Wilmar Hunter Sullivan_20190315

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au6ori`zqd, by-the� tafe of:No�th',Ca�olina,-Depirti-of-of Eri�ironm6htal Quality
"a.o n i pursuant to'] �A NCAC
and S
'8a�i�i_kei86r� )�o an �s' rnmission in an 7ar f e' N-rohnne�pa concern- p
R les at�tached:
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P jec•t Location Coun
ro
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StreefAd&ess/ State Road) '?t
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City
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Subdivision' ;Phone' Mail
Authorized Z_ City' P.-
Ailent 7
❑ 7
7 cW: Phone r B' i TS Riv* 6 as n
Affected.
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AtC(s): Adj. Wtr. Body-Xnat)an u nkn��
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Closest Mal. Wtr. Body ZZ, Z2
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-:,ORW: yes PNA yes / D - Cis
Type offroject/ Activity
NONE ANNEENNNE
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at pp i ficant PrintedNarn)d
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-gignatlure Please dico
e
_Ap motion Fee(s)
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Permit - iricer's Pi ted a
aternpig on back of permit Signatu'r6
Check# Issuing Dafe Expi!#. r).tp

Authm zed Agent C'onsentAgreeanent
I, WIIM AR gLS lmr- 450 0 1yA►d , herby authorize Tobin Jay Tetterton of
(Pio- perty 0w--ner(s) )
TIN Marine Constraetion, LLC to act on my behalf in obtaining CAMA permits_ for
the location listed below.
PROPERTY ADDRESS:
174 NC z�eo�
PROPERTY OWNER'S MAILING ADDRESS:
Zi2�l 17AyTo,d -.DR►.I
iCSa-1 AC: 27893
Phone No. 2.f2 2 90 //8.3
PROPERTY OWNER'S SIGNATURE: 494,4se
AUTHORIZED AGENT SIGNATURE:
;�
TOBIN TETIERTOX
DATE: 3
--// --
201/
W/Authorized Agent Consent Agnes.

'ENT 81MOMM. PROPERTY OWNER STATEMENT
t hGreby certify that l own propedy adjacent to A 1 MAK AAA rE 2 So I l nipu l I
propetbyl located at 8s0 wCs r
T5lA40 t/ Evl oAD +
{Addms,1! �� Blot Read, etc.
in c.T _ E/�vFot�C'OJa N.C.
Weegb®dy) (09yiTown andfor Caft�1
- The, applicant has described to -me, as shown below, the development proposed at the above
location.
f have -no oblection to this proposal.
PtaR�y
l have objections to this proposal.
Cites' atte
itl�R IDRA NS OF PROPOSED ®EE1;OPMEN
pr©po#ng developmment Must rill in descifpfib a -£velour,®, a I a -site
.d*andng)
NEIn� Il/�1�� �J�k1��iAD
fR BEGWON
i -understand that is pier; dock mvorina pilings, boat ramp, breakwater, boathouse, li% or iroin
must be set back a minimum. distance of IS from my area Of riparian access unless waived by
me. (if you wish to u�►aive the setback, yougm
� the appropriate blank below.)
Q l do wish to waive the IV setback requirement.
i de R@t wish'tD waive the 10 setback requirement.
Omer Q ioacsOBd� Frapark COAMer, WAG, lid--i
WVOOLZ
rN
Print or T a Name
2124 Lf.1/-T.,d I i �.lc
Co to
'Valid for one calendar year after signature (Revised Aw 2014)

r,
1 Herebycertify-€fiaf ! bwn prapet y adjacent to_ W,LmAr, k r4rR Jv I JAB! 's
60MV located at, 8SO I�Esr Ts 4IIiE�,I MO ps®perqj-cwnsq
on �►��c�,S. i�f FiZ (Address, Let, IBIG� Read, etc.)
acerb®�y� , in $6a-ik - -SeAt�Co2'r-- C'00A -rV N.C.
MWITOwn and/or Calm- j
The applicant has described to me, as shown b
location. elow, the development proposed at the above
adjao ae '� I. Dave -no objection to this proposal:
PTn-M7
MMad,- 1 have objections -to this proposal.
ad,- --�---^--
DRAWING OF PROPO
BED DIEVELOPINENT
{ir �ar�id� prop®sing 0%16Me t aaausi fill in des e pfion below 01, 026
Ch a sire dratWng)
nl€w Vld yL aUlk�,E,�a
WRSJE®N
a -1 u -must
be and that a pier, dock
nitist ,, mooring pilings, boat r mp, breakwater, boathouse, lift, or grojn
=: be set back a-m riknum distance of -I& from area m �!f you vWsh to waive the setback, you �a�s$ u�i�t the aof ro Hate blanks Unless
waived by
u t�
1, 1 do urrish°io Waive the IS setback requirement.
1 d® n@it,mfl8h tO wawa the IS'setback requirement.
can, (Adjacent Pftpeuty der wannalraosa)
Id �I-rC-�2 5"J W ar'r^ TeX ,� krn We r212
7r
Prin�`arT Name Prinio TyPam, f� n .�.�
lM WI, 7Addres iWff Address
� C a789.g
oNso
C►fyf5 afe2vp > CrZyfS atefZi r elC. . k rn Wo eg Q�
n-/Ii�(ArI?M�( Csl.tJC2— �i-�6�9 atio C.Onq
Tell ' hon A1u berfertall address y °" -
// 2 p f6 Telep ane Numberf emav -address -
Date
D
'Valid for one calendar year atier s'sgraaiure= (ReWasdAug. 2014)

C Division of Coaster . M. Habitat Impact Computer Sheet
��) fi r- _ �
Applicant: �//f //�'1 � f�U � ,
Date:1-!5 ��'' �e
General Permit #: 9� q
Describe below the HABITAT disturbances for -the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
�
redge,�]` Rig Other [I��b
v `_
y f �
Dredge Z Fill E4 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 ❑
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