63150D - Afify

�CAMA / ' DREDGE & FILL
r"E N E RAL PERMIT Previous permit #
New Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources _1
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7 • VZC-o
�,, n (� r'T1ElR les attached.
Name ! o 4 Project Location: County � � ity"
!� f �,.�,i 14, C,d f J ,{ ` StreetgAddress/ State Road/ Lot #(s)
l iiy T� t State aJG ZIPZC�i4(o tm Ll.
Fax # ( ) Subdivision l /
ted Agent _` '? ! n City 1 VOr Y� �/ .C� r 1 fX4 ZIP
❑ CW EW E PTA ES ❑ PTS Phone # ( G;A Wf E- River Basin
❑ OEA i HHF ❑ IH UBA ❑ N/A
❑ PWS: a FC:
es / no PNA yes no Crit.Hab. yes r nod
f Project/
>ck) length +----
n(s)
)ier(s)
.ngth
ember
id/ Riprap length
,g distance offshore=
ax distance offshore
:hannel
ibic yards
mp
use oatlift
3ulldozing
e Length
not sure yes
s: not sure yes
rium: n/a yes I
yes
Attached: yes C �j
ing permit may be required by:
Adj. Wtr. Body 15�2_1 uyiA P `?U Ur-J D nat
Closest Maj. Wtr. Body , r;,T ✓AA 50 U^IP
❑ See note on back regarding River Basin
la

MOHAMAD E. AFIFY 06/13
ANITA T. AFIFY
13480 NC HWY. 50/210
SURF CITY, NC 28445
o `
PAY THE
ORDER
OF
First South Bank
WILMINGTON, NC 28403-5T37
MEMO
66-7162/253' 11004
DATE Z / 2v/c�
DOLLARS LJ =--

pplicant: 01 o
ate:
3-6'/�
Permit #: 6 3 / 50 —D
>scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat Name DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impactsL
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact ammount
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 ❑
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 ❑

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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ 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:
S
--_. --- —. ccr7ini
A. Signature
B. Received by (Printed Name)
D. Is delivery address
If YES, enter delivi
❑ Agent
0 Addressee
of D Ivery
IZ
n Item 1? 0 Pets/
below: ❑ No
��. 3. S ice Type
`♦Certified Mal ❑ Express Mail
�] Registered urn Receipt for Merchandise
❑Insured Mail C.O.D.
4, Restricted Delivery? (Extra Fee) ❑Yes
2. Article Number ?012 3460 0000 6265 90?2
(Transfer from service label) 102595-02-M-1540
PS Form 3811, February 2004 Domestic Return Receipt
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ 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.
cle Addressed to:
auk
� -os
ucbe4)
A. Signatu
L L,Agent
"A 0 Addressee
B: ceived by (Printed Name) C. Date of Delivery
C L
D. is delivery addre from item 1? ❑ Yes
If YES, ent ow: ❑ No
CO
3. Service type
f�Gertified Mail 0 Express Mail
b Registered 4peturn Receipt for Merchandise
❑ Insured Mail EJ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7012 3460 0000 6265 9065
rr,.—far frnm service label
PS Form 3811, February 2004 Domestic Return Receipt
26
02595-02-M-154o

Postal
CERTIFIED
MAIL,,, RECEIPT
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PDO-mestic Mall Only,
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Postage
5
3
CorllNed Fee
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Return Receipt Fee
(Endorsemenl Required)
Postmark
Heie
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Restricted Delivery Fee
Q
;Endorsement Required)
Total Postage 8 Fee:
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Sfract, Apt. No.; '^
orBox No. I4, C"-' ......••-----
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:11IP41101
U.S. Postal Service,,.,
CERTIFIED MAIL,.. RECEIPT
(Domestic Mall Only, No Insurance Coverage Provided)
For delivery InfonnaUon visit our website at www.usps.comr,
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PS Form 3800, August 2006 See Reverse for Instructions