68533D - Inman

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Name of Property Owner Applying for Permit:
Al Inman
Mailing Address:
7101 Niblick Court
Fuquay Vanna, NC 27526
I certify that I have authorized (agent)
Joel Klass
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) pier, deck, floating dock, ramp, and boat lift ,
at (my property located at) 2431 Calvert St. SW Supply, NC
This certification is valid thru (date)
44 �� ��

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. Al Inman
Address of Property: 2431 Calvert St. Supply Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass
Agent's phone #: [phone]
Mailing Address: P O Box 279
Supply, NC 28462
1 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 or 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. Contact information for DCM offices is
available at www.nccoastaimananementnet/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
1
l l I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Al Inman
Print or Type Name
7101 Niblick Sourt
Mailing Address
Fuquay Varina, NC 27526
Cit1/Stata/7in ��•
(AdPre ner Information)
Signature
Nancy M. Sigmon & Clyde Hilburn Jr.
Print or Type Name
PO Box 125
Mailing Address
Lake Waccamaw, NC 28450
r',h,/Q}nto/7in

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A 1-0e J�V'4 ) ,S
(,N. am of Property Owner)
property located at _;?y3/
on -L� w
(Waterbody)
Tess, Lot, Block, Ro d, etc.)
in N.C.
(C " wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1; - 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)
S e e- A17-- ;c A-eJ--
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from 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' setback requirement.
1 do not wish to waive the 15' setback requirement.
Owner I
Si a e
�iruar✓
Print or Type Nam
(Adjacent Property Owner Information)
��. 14
Sig�talure
Iva, /a /
Princtt or Type Name �;

NC Division of Coastal Mgt. Habitat Impact Computer St
plicant: f`2 (� ��a �'5' D
te: 10/0
scribe below the HABITAT disturbances for the application.
I values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fim
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
abitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration ands
restoration or
and/or temp
restoration or
temp impact
temp impacts)
amount
temp impacts
amount)
oc/liDredge
❑ Fill ❑ Both ❑ Other
2
impact
j,41�
V V
Dredge ❑ Fill ❑ Both ❑ Other
0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0