63136D - Almkuist

✓�CAMA / 'DREDGE & FILL
31=—NERAL PERMIT Previous permit #
ew oModification ❑iComplete Reissue ❑Partial Reissue Date previous permit issued
Mkt
>rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC n /�CJIi�
�j �.• .} ❑ Rules a ched.
it Name b./7�h^!!<<+I"S / Project Location: County Al 7.,
L't%P/! 4 fi' fl"/ / AadJ State tV ZIP
zed Agent
CW ZIEW ePTA i. ❑ P-rs •
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
E PWS: ❑ FC:
yes /(rf I PNA yes k5 Crit.Hab. yes leol
Street Address/ State Road/ Lot #(s)
Z
Subdivision
City litl!'lllij�i%3�'t7� ZIP
Phone # ( ) River Basin
Adj. Wtr. Body f(nat.
Closest Maj. Wtr. Body
7r iMAMMON
■■■��..■t ���■i■■■■■■■■■■
ber
hannel
■■■a■■■■i■■i■■■a®■�=�:■■•�■■■■■■■
OL
ibic yards Erg
IN on III III
Mp ]INUT ON11001 1101§101MOMM
lulldozing
ii e IMV -0V.�/■■
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''1.0■■■1MINie Lengthnot sure AN
i
s: not sure
rium: n/a
Attached:
ing permit may be requirey:Y_/ See note on back regarding River Basin

,pplicant:
late:
Permit #: (� 7/ 3 cam'
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
.bitat Name DISTURB TYPE Disturbance total
Choose One includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or ternp
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)
s/3 Dredge ❑ Fill M' Both ❑ Other ❑
/
11GDredge ❑ 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 ❑

PAY
TO THE
ORDER
F AND S MARINE CONTRACTORS INC
PO BOX 868
WRIGHTSVILLE BEACH, NC 28480-0868
k' afto/m
3546
15-3/540
893
DATE
s
Q PN CBANK
8 F•:
DOLLARS

�'R-14-2010 08:52 From: Tc:9102563062 P.
AS 7-W
D R Resources
North Carolina Department of Environment and Natural
Division of Coastal Management Fray
Beverly Eaves Perdue James H. Gregson S�ec
Director
Govemor
AGENT AUYHQRl ION FORM
D ate: b ✓ L
-(I—:LW
Na a of Property Own r ApVrng for Permit,
owner's ailing Address.
,��Or�L-�%dry,
Phone Numbed
Name of Authorized/ Agent for this project
�, cis � �✓f✓
Agent's Mailing Address:
Phone Number L—LW=6:�
- Mt' hehalf, for the purpose of applying
i certify that i have authorized the agent listed above to ac
for and btairiing all CAMA Permits necossssry to 'install
f
(my property located) at >pw JAIWIJ �+ ? �.3
"C 4
M 2-6-,V,62
ertification is valid thru (date) % % �n . /�/A
This c 14140 r
Property owner Signature %'`7

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
'ILA /2 1 A �j 1,,0 1E1U 51ply'J'� )A, iv J&',
2 11�- I
1�6 )EY&I,
(Lot or Street #, Street or Road, City & County) `
Agent's Name #: �� %` ����'�� Mailing Address:
Agent's phone #: J� 31z,
I 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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been noted by Certified 4fail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, bo 2e, 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.
(Property Owner Information)
igrtature
Print or Type Name
(Adjacent Property Owner Information)
Si re
Print or`Type Name
Mailing Address
Mailing Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ,// n- �� /'J '` % t 1!'I 1?, " s
Address of Property: cU �` C L ��L L� ►Lir t; (l tl (�7�.�L
(Lot or Street #, Sireet or f1load, City & County)
►
Agent's Name #: < Cl%` 11011d LN /�� S Mailing Address: "k,
G. _
f a ,
Agent's phone #: ��L JZ�
I 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.
JL�—Ihave no objections to this proposal. I have objections to this proposal.
N 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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection ifyou have been notified by Cerdfied Mail,
WAIVER SECTION 41�e,
I understand that a pier, dock, mooring pilings, breakwater, bo 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.
(Property Owner Information) (Adjacent Property
Signature
Print or Type Name
4ennty4— (t6 L t e(-
Print or Type Name
Mailing Address
Son Nl l=�re,ehe �$, -Kfe (7-V
Mailing Address

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