63212D - Aiello

271406:52a Joel Klass 010-846.3360 p.2
E t u�
C-A�11A / -DIDREDGE & FILL 1�1 ? 639
ENERAL PERMIT
Previous permit #
New DModification ❑Complete Reissue ❑PartW Reissue Date previous permit issred_____�
1s authorised by the State of North Carolina, Department of Environment and Natural Resources
ind the Coastal Resqw Commission in an area of environmental concern pursuant to 1 SA NCAC,_
rpplicant Namrr.- Rulesattachod.
D _ Project Location: County_
Street Address/ State Road) Lot # s
State ZIP ail _ I t _�� St ''�1V
hone # b j � (}� Fax #
-�) Subdivis(or —
utElarixed Agent 1 t j` G _ __ Zlp
rfected 0 CW W I F' °� ❑ ES CI PTS # �_) River Basin -UY1h�
D OEA r, USA C� wa _ r
1-1 Pws:_--------•-_ _ , _ ., ------ Rdj. Wtr. Body
y r' ncr PA1A yea no
Crit.Hab. yes) a Closest Maj. 1NEr. Body —_..._
VFt of Project/ Activity . 1.LLt.f VUW VJ l7C I t %,i (_ 1(l t 1 to _Vf11 v-1 1,717 c,
'ter (dod) length 3 Male: _ Gn
77
. i -
_ .. _._.. • -__ r _
10- - -- --'—r --
f
;rap le.ixta
-_1 _�..�.-
t .
number l-
-- —4— 7—=---- —
Ivlkhead(P.iprao length C-_ • �--�`._ -a--� • -_ - - -Q- - - •---- --'- - �'-.
avg d1sunce offshoreOg-
_ t-
........_
max distance offshore L pxi
�
'�asln, channelcutic yards
-... _ -
ft
� i
oet ramp �- � --�-- - -,.. _;- -r-- -
;
T.
oathausd8oadi(: --• _
each wwoft
r
iarerxt,t Lectgth_•-.
kv: Bot sure yes no ' 1
I 3 !
rA-8s noz sure yc
,
,7i'dLDriUlTlt
rtla41 yes na
rotor ;•es a r _ � c - �p i r '
alver ktachPd: F.. i - r-,-_ .. .�:_. yes � - -(-_.�-__�_ - __..l-._..
,'Lidding permit may be requires b C��k'P�etl�
i ❑ See note on bark regart�g River Basin rules.
� i r7nn A. A ni 1 ,.11.. _ 1 _. _ f -1 . _ r - I a . s . ^

WESTERN MONEY WESTERN UNION FINANCIAL SERVICES INC. - ISSUER
UNION 1 O N I I O R D E 11 PayeCla at Wells Fa go Bank Grantl Junction - Downtown, N.A., Grantl Junction, Colorado 9 W (`.OIO/$(l0
---_,_._.____._.._..._._. __- _ En le
14-831626875
PAY EXACTLY
PAY TO THE
ORDER OF
PAYMENT FOR/ACCT. #
990-kll,.A--,
1: 10 2 L0040©i: 40 �4g 3 l6 268 7 58n�

C Division of Coastal Mgt. Habitat Impact Computer Sheet
�plicant: Co Permit #
ite:
�f
!scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
ind in your Habitat code sheet.
ibitat 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 fin
disturbance.
Excludes any
restoration and
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other w
co L
I l0 l
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 ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 3 - I -�" RO 1 '-4
Nance of Property Owner Applying for Permit:
'1fIFLL0
Mailing Address:
q A v � �ec4
I certify that I have authorizer! (agent) _ ) U CL j; L'A:5 S to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) (30,N T L ► r f
at (my property located at)�
ti C
This certification is valid thru (date) I Z- ► -%-cj I'-f
1
Property Owner Signature
-13--5101y
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that 1 own property adjacent to _
Property located at {Name of Pro s
(� l tr• f--�' pertY Owner)
on (Address, Lot, Block Road, etc.)
�
(WateY) , in ; I .
(City/Town and/or County) ' N.C.
The applicant has described to me, as shown below, the development proposed at the above
to
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)
4
+ � t
--- J }
WAIVER SEC N f understand tha a pier, dock, mooring pilings, breakwater,
back a minimum distance of 15` from my area of riparian access mess waivbo thouse, lift. or ed by must
t (if
wish waive 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.
tf-w Information)
Signa re
"�2:r
Print TyReN
Mash g dd ss
City/Stata/Zin
t Property Owner
Phni or
Math dd ss
'i' /-)�-

Postal
Service,
RTIFIED
MAIL,
RECEIPT
estic
Mail Only;
mwmm�
No Insurance
Coverage
Provided)
U777 C1 A L U S E
poft"
$
I— —
-IVA
Cortrad Fee
$3.30
09
s0.06—
PONWAOA
H"
=DOR� n=
MAO
$
$3.79
02126/2014
----- - -----------------------
Niwlis-amtc;,a ---- PU
cc,
MEL
UFF'r M A L U, S E'
poftp
�V.Tf
VV L Z.
CwWWd Fee
04
Sri. 00
erk
Hm
$0.00
mbp & Fe"
L$
02,`26/2014
''-- tA'1A.'2A
xw ----------------
--------------------------------
aKm--------------
,
Re�ers, for Instructions
Cp ( -5 7—el v P 54—