69237D - Northington

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oaacwacer marine uonsirucuon inc.
names Wiggins
BB&T
2910
$200,00 GP 69236D
6/2112017
Allied Marine Contractors
Russell Davis
First Citizens Bank
5641
$200.00 GP 69145D
6/21/2017
Backwater Marine Construction Inc.
Joseph Mainous
BB&T
2912
$200.00 GP 69250D
6/21/2017
Backwater Marine Construction Inc.
Jim Treadwell
BB&T
2911
$200.00 GP 69251 D
6/21/2017
Roger Bilheimer or Courtney Muller
same
Wells Fargo Bank
7151
$200.00 GP 69267D
6/21/2017
H&H Builders LLC
Bill Sanderson
First Citizens Bank
3918
$200.00 GP 69139D
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 96vv' �v (e4-C, IK f `, , Permit #. & 7g-7
�J r
Date: 0C14 `Ik1?
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.
Exdudes 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
Dredge ❑ Fill Both ❑ Other ❑
)30
6 Q
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [❑ Other ❑
Dredge [I 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 171 Other ❑

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
McCrory Braxton C. Davis John E. Skvarla,
wemor Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FORM
Date: p/ 7
ie of Pro erty Own
n�r Ap lying for Per it
eeZ
ier's Mailing Address:
'9 o �-
ne Number LY U)6 PX — at,.' a4.
N me of Authorized Agent for this project:
. (� Q_ Q,-J�t«.t6i Sc)
Agent's Mailing Address:
i
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
ind obtai ing all CAMA P mits necessary to install
�(JU -,\ c' c�
cons uct the following (activity :
\ (- (, ` cWU \ 1 y CL
my property located at
certification is valid thru (date) U) Csv rri �Q �L
s'�caG� S
Property Owner Signature Date

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Not
116 ZC IAyLo Address of Property:
(Lot or Street #, Stree
Agent's Namej
Agent's phone #-ft)
or Road, City & County)
�l' 1
Mailing Address: %OLr t �`
I hereby certify that I own property adjacent to the above referenced property. The individual applying for
this permit has described to as shown on the attached drawing the development they are proposing.
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 Divi ' p of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Corres a should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represenfel" owalso be
#W
contacted at [phone]. No response is considered the same as no objection 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.) .
I do wish to waive the 15' setback requirement.
IV I do not wish to waive the 15' setback requirement.
(Property Owner I formation)
tgnature
Print or Type Name
v
Mailing Address
� r�4\1y)
City/State/Zip
djacent Property Owner Infor ation)
,-;ignature
rl rWT' n"I 44,� r-5
Print or Type Name
47- / / �z re ril A4 6, Ce Ify
Mar ing Address
&,e,r,(& tits zap/
City/State/Zip
9 . h G ar-, c ,

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