67909D - Raynor

t7CAMA / ` DREDGE & FILL
3ENERAL PERMIT I
New ElModification ❑Complete Reissue ❑Partial Reissue
t a�� A B
Previous permit #
Date previous permit issued
irized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
/ ❑ �Oles attached.
it Name XB O v - Project Location: County-
'Ok
�x _ ,.-• v Street Address/ State Road/ Lot #(s)
State _-ZIP
b (?1a)5V7- 2-1!9—E-Mail
ted Agent L t4ll- / -Vtf0 0—
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❑ CW VEW `Al PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
yes /e!toD PNA yes
f Project/ Activity
length
>ngth
amber
d/ Riprap length
g distance offshore
ax distance offsha�e
hannel
bic yards
np
is oat'
not sure yes r, n`
•ium: n/a yes
yes
Attached: yes n
Subdivision
City !/! % ZIP
Phone # ( ) —"-- River Basin w!Z
Adj. Wtr. Body�T Oi z 5�yae✓� nat
Closest Maj. Wtr. Body lyd/Lt � S��N
(Scale:
ng permit may be required by: S (// ❑ See note on back regarding River Basin r
Local Planning lurisdiction)

NC Division of Goa6tai 09t, WORM IMP-8ct' GoMputer sheet
Applicant
✓ `
P ^�
Date: l -
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 W
(Applied for. (Anticipated final (Applied for. (An
DISTURB TYPE Disturbance.total disturbance. Disturbance disc
Habitat Flame Choose One includes any Excludes any total includes. Ex(
anticipated restoration any anticipated res
restoration or an temp restoration or ten
tem impacts)_impact amount tempim acts am
D ed e ❑ Fill ❑ Both ❑ Other l (�
Dredge ❑ Fill ❑ Both. ❑ Other ❑
Dredge ❑ Fill ❑ . Both ❑ Other ❑
Dredge ❑ Fill El Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ . Both ❑ Other. ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑'

Payment Proccessing Confirmation
Date Received 1 11/7/2016
-heck From (Name) KMQ Inc.
Name of Permit Holder Roy Raynor Jr
Vendor First Citizens Bank
Check Number 1024
Check amount $200.00
Multiple Permits No
Major/Minor
Permit Number/Comments GP 67909D
Receipt or Refund/Reallocated JD/2800D

PIWA
NCDENR
North Carolina Department of Environment and
Division of Coastal Management
Beverly Eaves Perdue
Jovernor,
Natural Resources
Dee Free
SecrE
AGENT AUTHORIZATION FORM
Date:
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
ALA 2wc2c Tr
wner's Mailing Address:
�a. Ryw ,w
fV_ 27SbtI
ione Number R ph
Agent's Mailing Addres
0 G�tM(e Wo9A
Phone Number(
;ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
r and obtaining all CAMA Permits neces ary t install or construct the following (activity):
iy property located) at i a V v
its certification is valid thru (date)

'4,oLdt'? 104--tb
KMQ, Inc
To: Mr Jones and Mr Graham October 6, 2015
From: Gary Ange, KMQ Inc
Re: Boatlift Construction on Raynor Property 9120 W 9th Street Surf City NC 28445
The Raynor's are adding a single boatlift to their dock system at the above named address. It will not be
an expansion of the current footprint or adding additional boat slips. It will be permited by NCDEQ
under General Permit 2000 and not require a CAMA major permit to be submitted.
Regards, Gary Ange
1�111-
KMQ Inc
526 Works Farm Road
Warsaw, NC 28398

r
■ 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:
J U W-t- Jc Os'
I I Cotiat� 1-34
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III'll' IIII IIII III IIII II IIIIIIIIIIIIIIII
9590 9403 0374 5163 1612 15
2. Article Number (Transfer from service label)
PS Form 3811, April 2015 PSN 7530-02-000-9053
A. %ig)%ture
X I ❑ Agent
❑ Addressee
B. Reqeived by (Pnnte Name) q`Date of Delivery
D. Is delivery address different from item V ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Expresso
❑ Adult Signature
❑ Registered MaiITM
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certified MallO
Delivery
❑ Certified Mail Restricted Delivery
ETReturn Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
0 Signature Confirmation-
❑ Insured Mail
❑ Signature Confirmation
❑ Insured Mail Restricted Delivery
Restricted Delivery
(over $500)
■ Complete items 1, 2, and 3. A.
■ Print your name and address on the reverse X
so that we can return the card to you.
■ Attach this card to the back of the mailpiece, B
or on the front if space permits.
1. Article Addressed to:
AV-. rA M
0o�- 10
13ev, -via 4
Domestic Return Receipt
O-Agent
❑ Addressee
ecei byy ( anted ame) C. ate of Delivery
Is delivery address different from item 1? ❑ Ye
If YES, enter delivery address below: zxo
JeNICe type
El Priority
Priority Mail Express
II
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IIII
III I
I I
I I
I II'
III
II
II
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II
I I
Ij.
❑ Adult Signature
❑Registered MaiITM
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
9590 9403 0374 5163 1612 08
Certified MailMail(R):livery
❑•
Certified Mail Restricted Delivery
:turn Receipt for
O Collect on Delivery
Merchandise
n n�io ni imnar !Transfer from service label)
O Collect on Delivery Restricted Delivery
❑ Signature Confirmation-
7 015 0640 0 0 0 6 8006
_
-�ail
7082 ail Restricted Delivery
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❑ Signature Confirmation
Restricted Delivery
PS Form 3811 , April 2015 PSN 7530-02-000-9053
Domestic Return Receipt

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