69100D - Zink

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1 \ 11111Ci
4/12/2017
Tommy
Perry/American First
Marine Citizens
Construction Inc. Cynthia Zink Bank
86655 $200.00 GP 69100D

plicant:C
te: tBbT
scribe belowthturbance
values should match the name, and
NC Division of Coastal Mgt. Habitat Impact Computer SI
s for the application.
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 fin,,
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
ibitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration andl
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount)
Dredge ❑ Fill ❑ Both ❑ Other ��jx
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

i order to obtain any
WJ?Ax
NC D t N K
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
James H. Gregson, Director
Authorized Agent Consent Agreement
is hereby authorized to act on my l
�nnted Name of gent)
permits) re uired�for�prop`erty ted below. The authorization is (smite
pecific activities described in the attached sketch.
.00ATION OF PROJECT:
PROPERTY OWNER MAILING ADDRESS:
-�2©c( PHONE NO. �t� N'�i1g'3!°� 0
.AUTHORIZED AGENT MAILING ADDRESS:
_ � go ©IAJV�, L.LCe r oa-8
SonxLA(n,I
-- PHONE NO. Ct t© "4 S
Signature of Property Owner:�� �� L�c-

Name of Individual Appiying For Permit~ 4 n cL �' `� ��
4ddress of i?ropert}j 1 l^ �{ ✓�' �" � �r-,
(tot or Street #, Street or Road)
r;�cK
.City and Courtly)
: hereby certify that I own property adjacent to the above -referenced props^}°. The individual
appl dreg for this permit has described to me as shown oa the attdmwirg .achednc deveiop ttky
are proposing. A description or drawing, with dimeaslons, should be crovided with this !Etter
have no objections to this propose;
If you have objections to what is being proposed, please ware the Di, islun of Cogs-4i
Management, 127 Cardinal Drive Extewion, Wilmington, NC 28405 or C:►ii 910-796-7215
within 14 days of receipt of this notice. No response is considered the some as no ob fttionif
you hove been notified by Certified Mail,
W AMR SECTION
N
I uadersmnd that a pier, dock, tttvoring pilings, breakwater, bout house or boat rift tnustbeset
bck a minimum distance of 14.' frorn my area of riparian access - un;ess %vaived b� me. (ifyou
�visb to waive tiie setback, you must initial the appropriate blank belo«. ;
'gn NAM:
do wish to waive the l setback reavire! -
J. don %visn to waive the 13' setboci:
Dl eta
print NamerT • ;'

I
!flame of Individual Applying For Permit: rx j a_
Address of Property 1(�)
i Lot or Street;, Street or Road)
;C1N and Cooty)
hereby certify that I own property adjacent to the above- referenced propc^y. The individual
tpplying for this permit has described to me as shown on the anached drawing me deveioprnm# ey
ire pro�+osing. A d scrintion or drawing, with dimensions, should be r_rovided with this k+er
Af/ have no objections to this proposa;
If you have abjec ohs to what is being proposed, please write the D►. i,i�,n of Cofis L
1+lanagement, 121 Cardinal Drivo Extension, WilminagTon, NC 28405 or call 910 796-7Z15
within 10 days of receipt or this notice. No response is considered the some as no obltctionif
you have been notified by Certified Moil.
WAMR SECTION
i uadersmnd that a pier, dock, tttvoring pilings, breakwater, boot :louse or boa: lift dmastbeset
bck a minimum distance of 14' from my area of riparian access - unless Nvaived b� the. (ifyou
wisb to waive the setback, you must initial the appropriate blank belo«- ;
do wish to waive the 1 seback reauirer--
1 do nz u-isn to waive the 13' setback -eo:;:rs---r,
17
AAA
Print Name

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