63129D - Trent

"1LAMA / DREDGE & FILL ��� 63
WNERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
;oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 07 4, )zoo
BRules attached.
i
Name t i Project Location: County 6,� u f+) Sw i c4e—
R( _i OR
i LK- 1 LState_ ZIP_
Street Address/ State Road/ Lot #(s)
()
Fax # ()
Subdivision
:dAgent &Ldt t�
p i►.-C--le -oP4
h :_. sty C� 1 Li _
ZIP 7 4
❑ CW 6?VW
ETA ❑ ES ❑ PTS
Phone # ( )
River Basin ( A11C
❑ OEA ❑ HHF
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body A% �Aj YN
/n
❑ PWS:
❑ FC:'�
W
fes / PNA
-'—/ no Crit.Hab.
yes / no Closest Maj. Wtr. Body
1�
Project/ Activity
LAt E PIL
� PLA-1—FU2NA
(Scale: 1"cL
k)length
bi�`2Jft X'a i y ieLV
Iu�hr,
gth
fiber
I Riprap length
distance offshore
: distance offshore
innel
is yards
p
e/ Boatlift
Ildozing
Length
not sure yes
not sure yes n
im: n/a yes
yes
:cached: yes
g permit may be required by: DA'Te I SQL A\A7 ❑ See note on back regarding River Basin

Division of Coastal Mgt. Habitat Impact Computer Sheet
:ant: 415 Tel Permit* Zel
21611+
ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
I in your Habitat code sheet.
at 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other,
3C
J�
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 0 Fill ❑ Both ❑ Other ❑

Bank of America 6296
ACH R/T 053000196 66-19/530 NC
ALLIED MARINE CONTRACTORS, LLC 08-03 58754
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443 /a-)
m
PAY TO THE ��//L
ORDER OF �
/dam DOLLARS U
MEMO �� / I � �1� �,�';.��
I /0 41A�

�f)o�
.�aL,
T

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date o� S
Name of Property Owner Applying for Permit:
"yw'- f,"�
Mailing Address:
,,�Sx,&-Y /fir
J--tS 41/ . -/� -_5� i
I certify that I have authorized (agent) Al ' ��r1i-le-- to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) 1:17�9' I—P. Y--1-Zj LAC —
This certification is valid thru (date)/���/

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: Y,:, i" �,/ lS/�•c
Q / (Lot or Street #, Street or Road, City & County)
Agent's Name #: / 1 / /� �hk MailingAddress:
Agent's phone #: 170 "a 32o�
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. roust 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. Contact information for DCM offices is
available at or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
-) 1l54 Cyo IL
AAndinn drWrpcc
(Adjacent Prope Owner Information)
Pik ✓�
*nature
"x JosAw A/ 6
Print or Type Name
�f�ol � Dµl�- �lu��►�
Madina Address

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
l<
N
��l
(Lot or Street #,'Street or Road, City & County)
Agent's Name #: 411rd AIYIP-- Mailing Address: off $ % it
Agent's phone #: ° to—�D1a"�530 S2
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 roust he 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. Contact information for DCM offices is
available at or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have 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.
— I do not wish to waive the 15' setback requirement.
(Property Owner I ormation)
Si /' a/tJ,ur/e
fkC
Print or Type Name
4 r" vim- f
(Adjacent Property Owner Information)
himi-Ab-
Signature
am�l &N—,Ef=
Print or Type Arne
{J-:I:- - AAA-