73508D - Maultsby

XCAMA / ❑ DREDGE & FILL
GIENERAL PERMIT
XNew ❑Modification El Complete Reissue ❑Partial Reissue
No. 73508
A B C
Previous permit #
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 15A NCAC
❑ Rules attached.
Applicant Name 13—say c XcAr-w.E. MANL.TSRy
Address PO go)C 62—(o
city F46Qe440oC State A ZIP
Project Location: County 13 R LAAl s w I C K
Street Address/ State Road/ Lot #(s) 4421
13 R A ^Yf Lx-- C% 12L S W
Phone # (qlo) &1%- 4976
E-Mail ffia►� es�;
Subdivision
A 1A
Authorized Agent
floAir-
♦ COM
City SNAL -tcr-r e .
ZIP
❑ CW )KEW
)(PTA ❑ ES ❑ PTS
Phone #
River Basin L(tK 6 c Iz
Affected
❑ OEA ❑ HH
AEC(s):
El IH UBA ❑ WA
Adj. Wtr. Body %�
I hi W nat /ma /unkn)
❑W PS:
ORW: yes / W PNA
yes / no
Closest Maj. Wtr. Body
� � � W
Type
of r . L< •
•
Groin
Bulkhead/ Rip length
avg distant ffshc
max distance sh
Basin, channel
cubic yards
Boat ramp
Boathous omatli X �-
'F 17 k-wo
Other 0 W = 3 d4 rV 2
Shoreline Length 't 100
SAV: not sure yes no
Moratorium: � yes no
Photos: �� yes no
Waiver Attached: yes no
A building permit may be required by: 9F4AAJSW 1 GtG (2ou.A+TY ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditionsy % _la I Zoo & At L oTH CIL LOCAL 01 5� /l ,1 D
FE'D£RAL RVCMIALA:LMAIS APPLY. PER.5oAUL WA'icRc-r.AFT C PWc-) DAVIT 1LIFT
A6111 MkL-JkJsy
Agerk or Applicant Printed N me
Signature " P ase reacicompliancgstatement on back of permit **
,0200 4* 24 ? 3
Application Fee(s) Check #
1 �1 l.EtZ I A C-C-liner-
Permit Officer's Printed ame
Signature
4-11%/20119
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 80 6 i b a- / � � iGkQI/L KL L' — f_ I _ Y
Mailing Address: LIL12 &,,4�-
1 1Y G r c( C
A/C, 2fs� 7 G
Phone Number: l4 - 6/ 7 , C 006
Email Address: v ifs y -e� " OGa-�i K� co
I certify that 1 have authorized 14J6�
Agent / Cohtractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Pve-t- d- nyc k
�� hstir L o
at my propertyJocated at PUxK-7 j, cs i jr S�� ��bt
in4_L L County.
I 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:
Signature
Print or Type Name
G- k c i-`
Title
Date
This certification is valid through

iy 77.
• 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 mailplece,
or on the front if space permits.
1. Article Addressed to:
a�G � %� l;� rvu1� � r�C � � rd F%,i e�
11111 IU 111111111111111111111111111111111
9590 9402 4454 8248 7493 64
018 0680 0000 ?028 882-11
A- SI nature
"I x btk
13 Agent
0 Addresses
I). Is delivay address c9ftent from Itern 1? 0 Yes
If YES, enter delimy addre low be. r.3 No
AU&4'� Z:
3. Service Type
0 Priority Man ExpressO
• Adult Signature
0 Reglstere Mall"m
• Adult Signature Restricted Delivery
13 S:I�V Mail Restricted
VIC&fifted Mail®
• Certified Mail Restricted Delivery
13
Vmh,=t for
• Collect on Delivery
MR
• Collect on Delivery Restricted Delivery
0 Signature Conflrmatlonlm
• Insured Mali
0 Signature Confirmation
• Insured Mail Restricted 1*llvmy
Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Retum Receipt
-W-P
a Complete items 1, 2, and 3.
C I
m Print your name and address on the reverse
so that we can return the card to you.
U Attach this card to the back of the MallPiece,
or on the front if space permits.
d sed to:
Y-6
16
V9590 9402 4454 8248 7493 71 I
T 8 8832 I.- A n
7 71,
A. Si
';gnature
11 Agent
J� I (-O�- (�— 41 0 Addressee
B. P A
,oceived j{6WNa") De
I jGfatqc
D. is delivery address different fr6m Item 17 u Yes
If YES, enter delivery address below: [3 No
3. Service Type
173 Adult Signature
C3 Adult Signature Restricted Delivery
V-tertfied Mal*
* Certified Mall Restricted Delivery
* Collect an Delivery
* Collect on Delivery restricted Delivery
0 Insured Mail
El Insured Mail Restricted Delivery
N
0 Priority Mail ExpressO
0 RegIstared Mail"
0 R Wvery
streved Mail Restricted 48 y
* Return PAK*]Pt for
Merchandise
* Signature Confirmation'tm
* Signature Confirmation
Restricted Delivery
....... ............ . Dorliestio Return receipt
PS Form 3811, JUly 2015 PSIS 7530-02-000-9053

C-,p
JJ it-�''I
v 'fit off` 4°'`'LAO
165 '
M`'"L Hs (, I

Date Recelved
Date De aped
Check From Name)
Name or Permit Holder
Vendor
Check Numer
Check
ounbt
Receipt or Rerund/Reallocated
Columnl
Column2
Co1umn3
C.1-4
Co.."
Co.
Column?
Column8
Column
4/1 i
Bobby Neal Mauhsb,
I Bobbv and M helle
Piedmonl Advartaue Credit U
T7