69023D - Goudreaux

■ 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:
SVG!,�k_D( YO L"
130Z 0CCOIr,,31��, .sf
f4l 14L., aecir, 1. Vk
A.
Agent
Addressee
B. Rdoolved by (Printed Name) [ ate of ivery
q. /
D. Is delivery address different from item 11 ❑ Yes
If YES, enter delivery address below: ❑ No
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❑ Adultt Signature
ElRegistered Tness
Mailp
9590 9403 0533 5173 1337 46
❑ Adult Signature Restricted Delivery
❑ Certified Mail®
❑ Registered Mail Restricted
Delivery
ElCertified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
^ ^ �•- - ^ • •—� • rr^�+ ^ r.^^, tea^ l^o lahall _
❑ Collect on Delivery Restricted Delivery
❑ Signature ConfirmationTM
71116 1370 0000 4733 7384
Insured Mail
Insured Mail Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
(over $500)
PS Form 3811, April 2015 PSN 7530-02-000-9053
Domestic Return Receipt
■ 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:
Mary (Acy -t i%4c
PoBo)(-Q9
Gorr,'e- v�.C-
.;?-V'f3�
A. Si nature
X ❑ Agent
( w 1 � ❑ Addressee
B. Received b rinted Name) C. Date of Delivery
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D. Is delivery address different from item j?<'OqYbs
If YES, enter delivery address below: g1No
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Priority Mail s©
❑ Adult Signature
aiITM
O Registered MailrM
9590 9403 0533 5173 1337 53
Q Adult Signature Restricted Delivery
❑ Certified Mail®
❑ Registered Mail Restricted
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
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016 1370 0000 4733 6592
n Delivery Restricted Delivery
Aail
❑ Signature Confirmationrm
❑ a
u �. " Mail Restricted Delivery
Deliveture ry
Restricted
_ I
(over $500)
PS Form 3811, April 2015 PSN 7530-02-000-9053
Domestic Return Receipt

NC 'Division of Coastal Mgt. Habitat Impact Computer Sheet
>pplicant: ove-3 c" CjG�c�v—cow�G
)ate: 65�(5 3/(b G
Permit #: b q6) S - (7)
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
'ound in your Habitat code sheet.
habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill Both ❑ Other ❑
O
000
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 El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

1P1302 From:
MOkid F- Eaday. Govmm
in order to obtain any
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rP1=';', j'31l ; i 17, --
NOM Camhm OePRatani+of EnvKonman and "eel Ftmumes
Owbion of COMW "M tap amit
4WAS K omega", Dk"kW
Ai>Yl110r Agm t Corksom A--
Wkfrl-
is hensby au#xwi=d to
--:dry -9910
Per'n*8) MgLmr for ttta PFoPei1Y %led below, The aL*Wri=W
sPecif c activWm dawtbed in am shed vk"c _
LOCATiOM OF PROJECT:
S

02/07/2004 19:20 9108429806 GREY tiC3LDEta
PAGE 01
M•+ •;
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Name Of Individual Applying For Permit:
Address -Of Property: /'2 ,&F�ena
.. , —° %-a,r-y county)
i hereby certify that I own- property ad j acent
referQnctd property- The individual applying far this to the above-
dascribed to me as shown ors the attached tLr *� Permit has
they are Proposing. A description or drawing,9 �a dQvelopment
Should be provided with this letter.With dimensions,
.�have no objections to this proposal.
I lift understand that
house, a pie...+-, dock, mooring pilings° breakwater, boat
Must be sat back a ninimue
frog ay aroma of riparian access unless `+aivad b distance of 15°
to waive the setback, You y me- (If you wish
below.) must initial the appropriate blank
1 do wish to waive the 15'satback requirement.
Y IQ-= Wish to waive the 15'setback requirement.
Punt Name

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