66509D - Bodenhamer

.37MA CaEDGE & FILL �f � NO 6f F'09 A B
N E j
L PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
I ❑ Rules attached.
t Name L. �cc� 1M_f/Y Project Location: County Q�'1J�Sw1
to w ��1D ✓1 L �l�- e. Street Address/ State Road/ Lot #(s)
Stated ZIP 303'0
`N0 4 ) $A3-33T'S E-Mail _ Subdivision
:ed Agent L oaz C OY\S�-YV [ I-)1 Y-\ City G C ZAy� �� 1 ( ��G1� � ZIP,SN
❑ CW 'XEW (*TA $FS PTS Phone # ( ) S, - 10 J CRiver Basin
/ LyM
❑ OEA ❑ ❑_HHF 6 IH rUBA ❑ N/A Adj. Wtr. Body CO AOL \ {J W V�/ r a�
❑ PWS: p,,
yes / no PNA yes / nClosest Maj. Wtr. Body j �t w�
o
f Project/ Activity
1 ,
ck)length L) x -�.
Li I
atform(s) 4 Y Q JJ
� Platform(s) I ,
ngth
mber
X
se/ Boatlift
e Length
not sure
>ttached:
�Oh
e Yli � .
Lo4
M
(Scale: %-
ig permit maybe required by: -TO W h { O cea h T-S\t' (coll
Local Planning jurisdiction) a I-. 1 _ w I
❑ See note on back regarding River Basin n

NC Division of Coastal Mgt. Habitat Impact Corr
Applicant: t�&V'fJ &4Lt.0%AV114r
Date: qla-/ )�'o(,
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
F
(Applied for.
(Anticipated final
(Applied for.
(f
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di
Habitat Name
Choose One
includes any
Excludes any
total includes
E
anticipated
restoration
any anticipated
re
restoration or
and/or temp
restoration or
to
temp impacts)
impact
temp impacts
a
OV"
Dredge ❑ Fill ❑ Both ❑ Other
amount)
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

A A4
LT'-N.-;AwA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton C. Davis
Governor Director
John E. Skvarla, II
Secretary
AGENT AUTHORIZATION FORM
Date: ,Tn,-. -2 9 Z e / l
ime of Property Owner Applying for Permit: Name of Authorized Agent for this project:
70 ✓/ t✓ .� _ �� oJC N N/+ r/+��t �i�ll L/ L`., &
Nner's Mailing Address:
lone Number (�o?�) e-}O 73>3
Agent's Mailing Address:
Phone Number (?/D )�T o 9-5'
ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obt fining all CAMA Permits ssary to install or construct the following (activity):
�r my property located at 9/ �aNG�n.� �9rdr' D.�.�.� T�������� A,/c
is certification is valid thru (date) -iv t.- c- 3a �a�t
Property Owner Signature Date

Mete items 1, 2, and 3.
your name and address on the reverse
it we can return the card to you.
i this card to the back of the mailpiece,
the front if space permits.
Addressed to:
�J e!A S�-
A.
❑ Agent
by (P4nted Name) R (1 Date of Delivery
Is delivery address different fromiterri l? ❑ Yes
If YES, enter delivery address below: ❑ No
II'I'I
I'II
I'I I
I I I
I I I
I III
I' I II
III
I II
I I III
III
3. Service Type
❑ Priority Mail Express®
❑Adult Signature
❑Registered MaiIT'"
590 9403 0603 5183 4327 21
❑ Adult Signature Restricted Delivery
rtified Mail®
❑ Registered Mail Restricted
Delivery
❑ ertified Mail Restricted Deliveryeturn
Receipt for
❑ Collect on Delivery
erchandise
Number (Transfer from service label)
❑ Collect on Delivery Restricted Delivery
❑ Signature Confirmation —
A
❑ Signature Confirmation
M15 0640 0006 3682
2123 dl Restricted Delivery
Restricted Delivery
3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receipt '
Ified Mail Fee C
a services s Fees (check box, add fee pp:rppppte)
Return Receipt (hardcopy) $ VV ��JJ�� ��
Return Receipt (electronic) $ *A 11- n11
Derttfied Mail Restricted Delivery $ Sil loci
4dult Signature Required) ^ $ $0. 00
Postal
o
CERTIFIED MAILRECEIPT
m
ru
Domestic
ru
•
ru
Certified Mail Feep #3 4eJ
4470
m
$ on
11
Extra Services & Fees (check box, add fee a$eopry p te)
❑ Return Receipt Qwdcopy) $ ilt . Lt�
C:3
❑ Return Receipt (electronic) $ ( ((
Postmark
r3
❑ Certified Mail Restricted Delivery $ %17 jll} _
Here
(3
❑ Aduk Signature Required $ 6(4.00
— —
❑ Adult Signature Restricted Delivery $
C3
Postage $Q , 49
E3Total
01 /27/201 d
Postage and Fleg.74
b
S
ut
r-1
Sent To 1 `
[�
-•--•----------------------------------------------
■ Complete items 1, 2, and 3.
A. Sigrpt (e
■ Print your name and address on the reverse
X
mlk�
❑ Agent
so that we can return the card to you.
❑ Addre
B. Rec ed by
C. Date of Del
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
elive
D. Is deliver;(
rentVmwm:
1?❑YesIf
t 1 ..
YES, PLe
rde
ddre❑ No

CERTIFIED MAIL. -RETURN RECgIPT REQUESTED
DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:: �A-/ ���1 k U �J
Address of Property:
(Lot or Street #,
Agent's Name #Q-! CQ � ���L�(1
-- Agent's phone #: %6- 5-1 C - Qmg s _
or Road, City & County)
�
ailing Address: llt� l 0
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 proposing.
I have objections to this proposal.
if yhave objections to what. is being proposed, you must notify the Division 'of Coastal
Management (DCM) in writing within 90 days of receipt of this notice. Corresp.9n4'snce.should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representttflves can also be
contacted at [phone]. No response is considered the same as no objection if you i►4o been
notified by Certified Mail.
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.) .
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Ow er Information)
Pint or Type Name
Mailing Addres
City/State/Zip
(Adjacent Property Owner Information)
SiJ,�I1Q(1!1'L'
Print or Type N me
,__ 3 tit/. I�; � S�•.
Maning Address
Or�4,41c �C, , V�-54(6
City/State2ip
-.._L....... A,...�.�1�.•.

CERTIFIED MAIL R�TURM REC�IPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONWAIVER FORM
Name of Property Owner:Ck�- --
Address of Property: _ \ ` W `�1 C�K' v�6 (U
�(� (Lot or Street #, Strefet or Road, City & court y
Agent's Name
Agent's phone S
ailing Address: lJt6wdl �''' j ` _X
yCQgFVJ � c:dl N( A69
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 drawin the development they are proposing.
tl,
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 Division of Coastal
Management (I)CM) in writing within 10 days of receipt of this notice. CorresRvnpience.shauld be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845.--DCM representooves can also be
contacted at [phone]. No response is considered the some as no objection !f you h beat)
notified by Certified Mail -_
WAIVER SECTION
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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Ow er Information)
( Cck enj�
C,.--F_---��---
Print or Type Name
U) _ `\d e")C�
Mailing Addres
\--n
Citylstatelzip
a n Prop rt Ow r Information)
int or Type Name
__moo �o
��yEQ D �
Mai i Address
p.,x&-9R o Ale 2 a (7.?
Citylsta eC /Z_ip "
/l ? 36 -s 99 /-/ 9� -----
i'Aranhnno Number �` Teldphone Number