Pedersen, Lynne

®❑CAMA / ❑DREDGE &FILL NO. 73963
GENERAL PERMIT Previous permit#
)gNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 I ��
/ © Rules attached.
Applicant Name Project Location: County
Address // . ` Street Address/ State Road/ Lot #(s) �`r , C(
City c , f r.� State ZIP .
Phone # ( 'ent ) - i % , / E-Mail Subdivision
Agent I 'K {
Authorized i'y I: T � I r i f City ZIP
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Phone# O River Basin
OEA HHF IN UBA N/A
AEC(s) ❑❑❑❑
❑ PWSAdj. Wtr. Body (7-0 -:\ ra CJ— (nat /man /unk�:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body 0 re f ` � `! - —
Type of Project/ Activity
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Agent or Applicant Printed Name
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Signature • Please read compliance statement on back of permit"
PermitOffcer's Printed Name /!
i
Application Fee(s)
Check# Issuii
Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: Lyh\1e IC ef14,e\1
Mailing address: 70 0 Ve \ \r \dw\� S 7 V (
Telephone Number: �5l�' )'WA" 2a`16
I certify that I have authorized I bx MowN\r\r✓ (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CA\MA permits
necessary for the proposed development of ( e-\J woos ev\
at my property located at
7o- 7_ Qr.
This certification is valid through
(Property Owner Information)
k
Print or Type Name
Title, co. owner or trustee for property
Date
�,6` -'�775
Telephone Number
q
Email Address
1\ K, 457
(date).

5
131107
I.33A
`Y 0776
1092-14-9
'ey` su 9329
I092.19.9
8332 )VV
1092-14-10
30 m o 4
1008,
Pamlico County, NC
2.n9n
2527
1092.17
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Pamlico County, NC
202 Main Street
Bayboro, NC 28515
PIN:
MAPID:
CALACRES:
ACRES:
ACCOUNT:
MAP:
BLOCK:
LOT:
OWNER -NAME:
OWNER_NAME2:
OWNER-ADDR:
OWNER -CITY:
OWNER -STATE:
OWNER -ZIP:
SITUS-ADDR:
DEED -ACRES:
DEED_YR:
DEEDBOOK:
DEEDPAGE:
SALEDATE:
SALE-AMT.
LEGAL-DESC:
BLDG_VAC
LAND_VAL:
TOTAL-VAL:
CALCIACRES:
6487600776000
1092-14-8
1.55281820483162
1.53
22414
6487
60
7
PEDERSEN LYNNE 8
7017 FAIRWINDS DRIVE
ORIENTAL
NC
28571
7017 FAIRWINDS OR
1.5
000407
38
8/25/2003
0
LOT 8 FAIRWINDS SUB
392369
115500
507869
1.6

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3
d
c

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
s Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
DCi':,Jh��1 ?`) v All
130 ����L� -)
A. Signature
'
X !"1 0 Addre
B. Received by (Printed Name) C. Date of Deli
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D. Is delivery address different from item 1? ❑ Yes '
If YES, enter delivery address below: .-UNo
Cox ,,y \ NC. 5 �\
IIIIIII IIII IIIIIIIIIIIIII Service Type ❑ Priority Mall Exprss®
13 A Signature ❑ Registered all�IIIIIIIIII IIII
❑ Adult Signature Restricted Delivery ❑ Reeggistered Mal RestrlcG
❑ Certified Mai lo Delivery
9590 9402 2653 6336 0921 68 ❑ Certified Mall Restricted Delivery ❑ Return Receipt for
' ❑ Collect on Delivery Merehandlee
2. Article Number(7ransferfmmservicefabefY ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation^
Tail ❑ Signature Confirmation
7018 0040 0001 0846 5769 ,al ResMc ed Delivery Rastrc ed Delivery
_.._ _... __..... 01
Ps Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
i
Is 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
�ieve'V\ OrnkICk/
107Sl�c�r'�
F'i,'yeA
X / /f, w /n
❑ Agent
D: Is delivery address different frdn item 1? U
If YES, enter delivery address belowo 13
Of
Service Type
3.IIIIIIIII
❑ Priatty Mail Expr ®
❑ Adult 6le Signature
13
❑RemoRegisteredMal
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III
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❑ Adult Signature Restricted Delivery
❑ Registered Mail Restrict
❑ Certified Mail®
D mery
9590 9402 2653 6336 0921 75
❑ Cedifed Mal Restricted Delivery
❑ Return Racellpt for
❑ Collect on Delivery
❑ Collect on tDelivery Reenlcte l DeIIVary
ise
❑6 nature Confimutbn*
O Signature Confirmation
2. Article. Number i7lansfer from service labell
7018 0040 0001 0846
5752 it Restricted Delivery
ResMcted Delivery
Ps Form 3811, July 2015 PSN 7530-02-000-9063
Domestic Return Recelp

I II I � IIII ����Il�l II I II I I I II II I PSP tlNo. G-10 Paid
9590 9402'�95A %336 0921 68
United States
Postal Service
'ender: Please print your name, address, and ZIP+q® in this
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LISPS TRACKWG #
First -Class Mail
III II I II IIII I I I Ii I i I I l i USPS Postage &Fees Paid
Permit No. G-10
9590 9402 2653 6336 0921 75
United States
Postal Service
ender: Please print your name, address, and ZIP
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