74293D - Raynor

r. ' A CAMA [ ❑ DREDGE & FILL NO. 74293 A B C DD
GENERAL PERMIT Previous permit#
XNew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality na I'
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1/ / �1 •d cc) U
po /, ❑ Rules attached.
Applicant Name J%Q v, d d S�'�7 ✓ Project Location: County
Address PQ&9'r 70 Street Address/ State Road/ Lot #(s)
City /,',I &�, state VC ZIP aas 6 a35 F o ,cl a &fpyC
Phone # ( ) E-Mail SVP�rjd ✓J /�i a 4��
Authorized Agent A'I,d /r'j pc ov✓*'S
Affected ❑ CW QEW ❑ PTA ❑ ES ❑ PTS
AEC(s): El OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / C PNA yes / ©°
Type of Project/ Activity Prpe54r 16
Subdivision
City CAIrloo tdty ZIP
Phone # ( ) River Basin
Adj. Wtr. Body Cu i'CAM &.� 4C///,A>;Zrar /man /unkn)
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A building permit maybe required by:
( Note Local Planning jurisdict6iW
Notes/Special Conditions `i Aw .5
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
�0() P-1-1201
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
1)�7N. ;�aoo aq le64, ad'e«y il-I
a
P��P inted � e
Signature
S f I — 147A
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
L�2�'-V a
Phone Number:
Email Address: e ra ti loors
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at J �CGco /vh^ �.?4,Ile
in &) it County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Print or TvDe Name
Title
3 122_,a0/9
Date
This certification is valid through � 1 1 �O
XC

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach thls card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to:
c: &2 rt Cl-,k--- //0 n S
p �oX i3©
&t ki r)
1 ❑ Agent
/ ❑ Addressee
by (Printed Nome) C. Date of Delivery
Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
, 4N NC �8
I
I
I I
II III
II I I
II
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IIII
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.nn ❑ R ority Mall ss©
3. Service SigMaiITM
❑ Adult Slgnat�U1,7 ❑ R
nature
❑ Adult SignatDelivery
gistered ail"
❑ gistered Mail Restricted
9590 9402 4298 8190 9506 23
dCertifie Malivery
❑ Certifie aelivery
❑ eturn Receipt for
❑ Collect on
❑ Collect on DDelivery
Merchandise
Slgnature Confirmation—
Signature Confirmation
2. Article Number (Transfer from service label)
7 018 0 3 6 0 0 0 01 1313 7 3 0 0
re4 Mail❑
red Maillivery
Restricted Delivery
r $500) ..�'
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
■ 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:
""f � mark
261 G— /c�rtkjr_, Ave
C_aA 9,(,LI & Aeact-7 1&jC
V42X
I II IIII III IIII II I IIII I I III I I I I
9590 9402 4298 8190 9506 30
2. Article Number (Transfer from service label)
7018 0360 0001 1313 7294
PS Form 3811, July 2015 PSN 7530-02-000-9053
A. Signatur
X dent
Addressee
B. Received by (Printe N e C. Date of Deivery
2
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: _)F No
3. Service Type
❑ Priority Mail Express@
❑ Adult Signature
❑ Registered Mail-
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certified Mail(D
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
D Signature
Confirmation-1--fired
Mail
❑ Signature Confirmation
fired Mail Restricted Delivery
Restricted Delivery
r $500)
Domestic Return Receipt

fr a j c e.-iA— To o,,.l I
/>G GEC
N�
,r

Date Received
Dare De s/ted Check Fmm Name
Name o/ Permit Holder
Vendor
Check Number
Check
amount
Permit NumberlComments
Receipt or Refund/Reallocated
Columnl
Col-2 Column3
Co/umM
Colu-5
Column6
Column?
Columns
Co1umn9
11 19 Caoe Ch ners LLCID—d Hi - n Sue Ra k f A— - 1 (
P < 3 PA r 4