69171D - Healing

�CAIVIA
/ DREDGE & FILL o',�1 ; �.:r;
MEN ERAL PERMITlo\Previous permit # A B
ew El Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources 7
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (,/ � 1 r • I �l � b
_ L El- Rules attached.
it Name (('1 ill Fi/I� / `Project Location: County 7
Street Address/ State Road/ Lot #(s)
IM ty\k VA State ZI M vII f lka
() �''o^ E-Mail�DhWlb�5ubdivision
zed Agent M 1 t f t Qd I-0 V1 City s�1q 1 Q r—C ZIP � g
i YCW CXW XPTA ❑ ES ElPTS Phone # l tL v ) — S 03 b River Basin Wm
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A S(I
ElPWS:
yes /(no PNA yes /�
f Project/ Activity:
-1 o h n C� o f
)ck) length
latform(s)
Platform(s) (�
:ngth
ember
id/ Riprap length
,g distance offshc
ax distance offsh
hannel
ibic yards
mp
ise/ B t
W
Adj. Wtr. Body in U rLN- M--W
Closest Maj. Wtr. Body /qq ,1 WN
(+ ck I(Af)i Ja�rd aCC-
(State:
i'1�

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: I l CO Co Permit #:
Date:
0916(- /4�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found 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 fina
disturbance.
Excludes any
restoration and/c
temp impact
amount)
V (�
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 ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: E-}► IGIa M Pcga+�-
Mailing address. 3141 H0 r*-Fax RoQot-
W (m►"I! jinn fv L a3
Phone Number: q I D) �7 D -11-zo
I certify that I have authorized MikeL 0�
Agen / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 0, dor Ik
at my property located at
inun$WI`Ll�.
This certification is valid through
(Property Owner Information)
M'
County.
Date
S
SigrKture Q LL rl,, p
I111 A... M P' N1a.-- 1 lgOT'� I�G r� �1 0A
r' Print or pe Name
� a.u�,t-r1-c►�
Title
NC 2F
A 1. - I "

ell, Sean C
n: Mary Kerr <[e-mail]>
;. Monday, April 17, 2017 10:51 AM
Farrell, Sean C
iect: Docks
►ean. I am power of attorney for my mom Hilda Pigott @ 1606 Village PT Rd & representative for The
ling Water Company @ 1614 Village PT Rd Shallotte,NC. Fiduciary for McKee Pigott. Thanks. Mary
>tt Kerr. Have a great day.
t from Yahoo Mail on Android

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t .j-u.� bilk" Ca.
(Name ofo ert Owner)
property located at /G 14 `/,r.,e,e,�,�� /�a.t,,,�,.� xox �(�
(Address, Lot, BI ck, Road, etc.)
on JJ'A� , in d' , N.C.
(Waterb dy) (City/Town and r County)
The applicant has described to me, as shown below, the development proposed at the above locati
_/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bac
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to m
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 Owner Information) (Adja e t Property Owner Information)
qt 40A
Signature Signature i
NI Iola Psaol-f b0 - 7 P�Qo re AA
Print or Type�e Pn t ?rITYpe Name
3q `i I HQ ( (AOLY Qva►o�- ��- i// s1 % �/

■ 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:
cD
A. Signature
< .
X
B. Received by (Printed Name) C
D. Is t address affdrW f it
If YES, enter delivery address low:
i � 4
3. Service Type " y� �� ❑ pr;r
Adult Signature 0 REK
II 1111111 Jill
I'IIIIIIII II�IIIII III III I I III n aIr Restricted Delivery ❑ Del9590 9402 1661 6053 1752 07 J',Adulertified
ertified Mail Restricted Delivery ❑ Me
� Collect on Delivery
2 A..,,.io nip,. h— IT, —far frnm --ira lahall ❑Collect on Delivery Restricted Delivery ❑ Sig!
El7 016 0 910 0002 1223 6479 Restricted Delivery ReE
Rey
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domes

� y Man � , �'� yes Const�ruct�ion
R
ado
3500 x3
-- zs Ft Py�o�s
ZY�} Ham rc, Z cop,_ ZX fors
X bi'ac i/1 Acz4c
2-X6 �ecers
36 �.i7. �rlp
oloc�
AL-L %e cis Wao,;LC 1.41e, 4 6 is
/) oc p20 700 Y3
Roaf,p� ��o a SO
) le