67158D - Smith

CAMA / DREDGE &FILL
U A B
3 NEF L PERMIT Previous permit#
44ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources —7 l h
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC t (� (t) U
❑ Rules attached.
t Name 1 Project Location: County'tSvi�
` �'C V 1 1 Street Address/ State Road/ Lot #(s)
State ZIP
(—W) Subdivision
ed agent iN� �' �(- S 00 JCity �(3` M ZIP � t
ElCW ElEW ElPTA �jES [<PTS p PKone # (�Q) �� River Basin
❑ OEA ❑ HHF ❑ IH '❑ USA ❑ N/A
❑ PWS:
yes / now' PNA y
Project/ Activity
:k)length
uform(s)
Platform(s)
igth
nber
3/ Riprap length —
distance offshore
x distance offshore
cannel 1
)ic yards_
ip
se/ Boatlift
®Mw.!Ilr�KI
Length
not sure yes
urn: n/a yes
yes
kttached:: yes
in C
..
Adj. vvtr. Body GLV1 (nat /
., A
ig permit may be required by: TZ7V/^ b 1 I'll >ri(t V ► ❑ See note'on back regarding River Basin rL
_ocal Planning jurisdiction) 17 _--1 f ` fr ^i Iy

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: M �V,,c �50 V \
Permit #: ('07, 5 $'--
Date:
Describe below the HABITAT disturbances _for _the anOication. All values shoukLmatch_th_e name -and unmmente
found in your Habitat code sheet.
TOTAL Sq. Ft.
FRAL Sq. Ft.
TOTAL Feet
FINAL Feet
(App)ied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/oi
restoration or
I and/or temp
restoration or
temp impact
Dredge ❑ Fill`{] Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge.❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge [] Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both �] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

MRRI
North Carolina Deparanent of Environment and Natural Resources
Division of Coastal Management
Beverly Eames Pend w James K GMPW Dee Freeman
Governor Director SwMary
AGENT AUTHORlZAT1ON FORM
Date: l _' / `t " l u0--
Name of Property Owner Applying for Permit: Name of,Aut, oild Agent for this project:
OWner's Malling Address: Ak
? 1
R,., it, r A &L -171, 7
Phone Number &I 't ac Tn
Li
Agent's Malting Address: f l
Phone Number ( i 6) .� 7 --U3
t certify that 1 have authoriied the agent listed above to act on my behalf, for the purpose of applying
obtaining all;CAMA Permits necessary to install or construct the following (activity):
(my property located) at t 15 I n 14
This certification is valid thru (date) 9 -1 G,
'2-)'1c.% 7-2 s 1k
Property Owner Signature Data

07/15/2016 16:01 9108421690
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PAGE h1
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! f► i i ' ! i 11:�
I harcby cm* diet I Own paoperty Aacemt tO '��i r �C lc-" 'S
PmP�y located at 5 n _� (Name of Property Owner)
on
B'�tZ�l °ad' eu
(waterbody)
AWUcaa;t's phone #:_ 5{ - 5 i 3 (Town and/or Co")A - 71S Niel
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1 3CI
Hd3he has described to zone as ahawn below the &mWopmmtTbe/s(btesproposing at 10cation,
and z have no objections tD the proposal,.
DESCRIPTION AND/OR DRAWING Olt PROPOSED DBYELOPMENT;
(1ProP""g d"dOPment mrtsf f U in drscription bylaw or attack a site drawing}
If You have objections to whit is bdag proposed, you must notity the DhWou of Coa:dl within 10 days of receipt of this notke. Cotnspoud mce should be mailed to ]�:7 CardiHal Drnre � g�H� DC'M hpresealadm can also be costle d at (R CD 796
-72
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e si1L1e as no Oble�flpn 'f vnn lti a i1ECII Hottiitd b7 fio Ad.:1
Signature
Pxkt or type Name
3,�Z3
Mailing Addrm
`do,
— - - -- n.n n,
Property Owner in&rmAtionj
S*DRWM
.3"0v) 4 L, 5a- `auaye
Print or Type Name
M iling Address
NA (CAlalul G u
city / state / zip

CANAL
=>--� N
-----------------------------------------------------
John 5uarez Mike Smith Elliott Shaver
113 Tuna Or 115 Tuna Or
Holden Beach NC 28462
528-42q-5133
111 Tuna Or
q 10-361-2354
elontuna@yahoo