66555D - McClellan

CAMA /'❑ DREDGE & FILL 1� v A B
IENE„RAL PERMIT l Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized 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 Rules attached.
:Name (2 a'\ � Q l N C i-�Al \� 1 �` \ l' e,I a ✓\ Project Location: County �y ins K
C] a S Street Address/ State Road/ Lot #(s)
\v �\(. Q �, State Zip �.�� T iI 00
(g)Subdivision
��� " �� E-Mail ��j ,`',�
ed Agents �� �\ f7V �� 5 �C`' JC� �rl City \Gl����{, ZIP �r
❑ CW C�'TA ❑ ES ❑ PTS Phone # ( ) River Basin �vW
❑ OEA ❑ HHF '❑ IH ❑ UBA ❑ N/A Ad'1 Wtr Bod � rV krt ,Wik � na i
❑ PWS:
yes / Ino , PNA es / no
I' Project/ Activity ( V o'
Eck) length
atform(s) "l�` 0
Platform(s) - -- }
:ngth
amber
kd/ Riprap 14
g distance i
ax distance
hannel
ibic y ds
mp
-Al Boadift
i�
3ulldozing
ne Length
Y
Closest Maj. Wtr. Body
�V-
not sure yes (no —
i
)rium: n/a yes eno
yes /no
Attached: .yes no ( ,
ling permit may be required by: QA) ��5 (!— CC'
-(N A V1 L '
(Scale: j
❑ See note on back regarding River Basin
Local Planning lurisdiction),.

NC Division of Coastal Mgt. Habitat Impact Con
Applicant: C&V\�C4VAy�C � t ( � a �j
Date: ll /}� /� L
T 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.
(/
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
d
Habitat Name
Choose One
includes any
Excludes any
total includes
E
anticipated
restoration
any anticipated
rE
restoration or
and/or temp
restoration or
to
ternimpacts)
impact amount
ternimpacts)
a
Dredge ❑ Fill ❑ Both ❑ Other N,
'
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Vol
Mailing Address:
n w d
I certify that I have authorized (agent) /J, �/ f�d�ylu's to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) fie /� � rt/G�y� Glit� ,11j3417a��1►nc,C / /-00 trn oelfff )
at (my property located at)
70 - 7, > �fi`leS1aIlee- At/
�allQf�'j �C z�Y7rs
This certification is valid thru (date)
Prnnerty nwnerRi"nfnre
'3-22-t b
rhtp

■ 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.
. Article Addressed to:
( 3l,�f�
le L t� /�/ziO3 26
111111111111111111111111111111111111111111111111111111111
9590 9402 1443 5329 1793 96
2. Article Number (transfer from service label)
_ 7015 1520 0002 4184
PS Form 3811, July 2015 PSN 7530-02-000-9053
■ 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:
Aell� I��CLu�r
216 /f/fe—($&-L t24,
115R" y C Ile v,, /lei tic
2 43 76
A. Signature
%/
El Agent
,Tt ,,
� , v
❑ Addressee
B. Received
Tint Name)
C. D to of eLvery
3
_'�v
livery Nddress
different from item ?
Elyes
If YES, enter delivery address below:
❑ No
3. Service Type
❑ Priority Mail Express6
❑ Adult Signature
❑ Registered Mail-
❑ Adult Signature Restricted Delivery
❑ Registered Mail f
❑ Certified IVIZO
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
El Signature ConfirmE
❑ Insured Mail
0 Signature Confirma
9434 Restricted Delivery
Restricted Delivery
A. Siig�nature
X nc). liY �jfJ`
B. Received by (Printed Name)
Domestic Return Rec
❑ Agent
❑ Addie
C. Date of Dqft
' !/L7
D. Is delivery address different fro item 1 ee
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
❑ Registered Mail -
IIIII
III')
I I
I I
I IIIII
I
I I
II
I it II
I I
El Adult Signature Restricted Delivery
El Registered Mail Restricted
❑ Certified Mail®
Delivery
9590 9402 1443 5329 1794 02
0 Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
2. Article Number (transfer from service label)
❑ Collect on Delivery Restricted Delivery
Signature Confirmation"'
7 015 1520 0002 418 4
9441 1 Restricted Delivery
0
Restricted Delivery ion

OS MAIL
�L
f'
CERTIFIED MAIL. — RETURN REt: KY1 REQUESTED
b. ecT/o 1
DIVISION OF COASTAL MANAGEM&N- T
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property:
Applicant's phone 4:
�ihcJ
cCle %/Qi2
(Lot or Street 9, Street or Road, /City & County)
Mailing Address:
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. A description of drawing
with dimensions, must be provided with this letter.
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 (DCM)
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Eat
Wilmington, NC 28405-3845. DCIVI representatives can also be contacted at [phone]. No response is
considered the same as no ob'ecdion if you have been notified b Certified Mai1.
WAIVER SECTION
I i..Jerstand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
15from 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' set back requirement.
I do not wish to waive the 15' set back requirement. `
(Property Owner Information)
Signature
Print or Type Name
Flailing Address
(Riparian Property Uwner iniormauon)
1
Signature
�yr� �f ra �Te /
Print or Type Name
I/ G /Ve//I 2 UYo
Mailing Address

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