62635D - Davis

❑ICAMA / ❑ DREDGE & FILL
/
GENERAL PERMIT
Previous permit #
❑New [-]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
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Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
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Project Location: County
i Rules attached.
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✓ (
Street Address/ State Road/ Lot #(s)
State NO, ZIP Z� 513
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# I,J % -?284 Fax # l t 45Q - 07—(9
Subdivision N
ized Agent Y1—VA MV 0-4� n'
City 0 e &A."kC
ZIP —al 6
❑ CW T, EW 3 PTA Li ES ❑ PTS
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Phone # )
1
River Basin w rn
❑ OEA ❑ HHF ❑ IH L UBA ❑ N/A
•'.
Adj. Wtr. Body l�tA�/1�
(nat
❑ PWS: ❑FC:
f �'1 � fwvi
yes / no PNA yes / no Crit.Hab. yes / 0�
Closest Maj. Wtr. Body
A Project/ Activity
ock) length 1-T X
M(S)
pier(s)
length
umber__
ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubicyards i
imp
)use/ Boatlift
ne Length
gs: r
)rium:
tt.IL4 o
(Scale:
ling permit may be required by: ILAN11 it L/U(M I
❑ See note on back regarding River Basin

NC Division of Coastal Mgt, Habitat impact Computer Sheet
Applicant: t� Permit* (Z& 3SD
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
found in your Habitat code sheet.
Habitat 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 fir
disturbance.
Excludes any
restoration anc
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 0 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

A -DC 3832565 MMIMM
-DL 3371823
3557
/c7— 16 _ 66-112/531
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100 5 19 4 500 13 21to0 3 5 7

US MAIL . /5 ,eqccr-
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: 17 44-,,r02 .ST Ale �j�,tlsldlC�
(Lot or Street #, Street or Road, City & County)
Applicant's phone # 96-go/-Q�� � Mailing Address: 908 LI1WTC� fl%CKO�/
9'/9- (osb - 304P> �'A,e AIC 27YI
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permi
has described to me as shown on the attached drawing the development they are proposing. A descrintion of drawing
with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If 4 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 Eat
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 notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance o
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.)
L/ I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Inform
-t- 4------w-- - --- --
Fogoq �i�ii5rivc 7/fawty
Print or Type Name
Mailing Address
P" - - AIA 7-72n
(Riparian
Lllelo"- C140-
- T M(Aj
Print or Voe Name
1/&o OAK G101C, CAUA-r ( 91
Mailing Address
vvl , -.n # f / 7 72n 9.

S MAIL /9 Az-7-
CERTIFIED MI AIL - RETURN RECEIPT REO UESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ne of Property Owner: &;7u //
iress of Property: Z. J�7 QL'f�'l 1 SLL-` `��f,�'l� /i�C' `�✓�Clr/SC
(Lot or Street #, Street or Road, City & County)
)Iicant's phone #: 919-6CC Q gc z o Mailing Address: �O � lei �/1 ///C Q/161
x/e -Z75
:reby certify that I own property adjacent to the above referenced property. The individual applying for this permit
described to me as shown on the attached drawing the development they are proposing. A description of drawing,
h dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
IOU have objections to what is being proposed, you must notify the Division of Coastal Management (DCM)
vriting within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Imington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
isidered the same as no obiection if you have been notified by Certified Mail.
WAIVER SECTION
►derstand that a pier, dock, mooring pilings, breakwater, boathouse,_ or lift must be set back a minimum distance of
from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
�ropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
-operty Owner Information)
,nature
tit or Type Name
(Riparian Property aTynAr Informa(tio�n) n
Signature e0&-;Pa
Print or Type Name
93 S,vTL-:CdALG ��
tiling Address Mailing Address
/ 1/ _ A / r — Ham. „ i—

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Orly Eaves Perdue Braxton C. Davis
ernor Director
Dee Free
SecrE
AGENT AUTHORIZATION FORM
Date:/o -1-/.4
of Property Owner Applying for Permit: Name of Authorized Agent for this project:
�r's Mailing Address:
'8 a�4rce
Ne
Agent's Mailing Address:
/ 790 ,cE.ewoo7> 77tA1c Na
NC Z 6 V(- z
Number 036) 501 - 82- 8Y Phone Number (910) 6,Zo - 0-,197
919- Gso - go z 0
�y that I have authorized the agent listed above to act on my behalf, for the purpose of applying
d obtaining all CAMA Permits necessary to install or construct the following (activity):
>LAcC s 7)0 O-Z .
iy property located at ,fT. 02-0 NC
ertification is valid thru (date) /.t /3
Property Owner Signature
Date

7-3 7Z)/J U%G!/RLL
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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:
7 OGZS,
-
A.
❑Agent
q6-0�4- ❑ Addressee
B. Aeceived by (Printed Name) C. Date of Delivery
D. Is delive dress different from item 1? ❑Yes
If YE e delivery address below: ❑ No
3. Service Type-''
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number (Transfer from servic 7010 3090 0003 7157 9068
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M-1540
PostalPostal
CERTIFIED MAIL,r� RECEIPT CERTINED MAIL,,,
• •
(DomesticOnly; No Insurance CoverageProvided)
O For _u
El-•1 information. O
Iti
Ln
r-9 Postage $ Lr) Postage $
f� Certified Fee ¢.?. i'! Ili �
Certified Fee $4 10
MReturn Receipt Fee _� Postmark rT i
(Endorsement Required) Here / Return Receipt Fee Postaa k
p C3 (Endorsement Required) $2• �`Here
O Restricted Delivery Fee
(Endorsement Required)CD Restricted Delivery Fee 1
j (•
O l� (Endorsement Required) g!? }? O
0- Total Postage & Fees $ $6. 11 09/30/201 , Er
O Total Postage & Fees
m ED
Sent To M
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r-i S`treet, Apt. No.; �/ _ _.___.
- ' — rl Street, A (No. i -�--s
--------------
p or PO Box No. P z
O or PO Be,, No. �J L - ------------ ----'- -
------------- '---------------------
City,State.ZIP+4 �------------------------
n ���e �l a 73� ,/ r Clty, State, ZIP+4 � e Reverse for Instructiorg 0,7(Q
�O D�
:rr rr. oc
:rr August 2006 See Reverse for In
■ 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 tl�e ailpiece,
or on the front if space permits.
A. Signature
X ❑ Agent
r- ❑ Addressee
B. R ived Printed Name) C. Date of Delivery
D. Is deliv ry addrp-�,a rl!ffmmnt f-- it— i o rl V..