61645D - Hamm

❑ CAMA / ❑ DREDGE & FILL ^ ,j
GENERAL PERMIT Previous permit#
D,New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
prized 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
❑ Rules attached.
nt Name Pthno, M Project Location: County I I-
s� 4{ 2-- Street Address/ State Road/ Lot #(s)
1 tJ > t�cP4IN. State N cIzi
� ,Fax # ( ) Subdivision zed Agent 1�2 ?,2 NE CiI r-A-7-4 ZIP
i ElCw p Ew :W PTA ElES ElPTS Phone # ( River Basin
❑ OEA ❑ HHF ❑ M ❑ UBA ❑ N/A Adj. Wtr. Body 5 p C'i D�-1 el 0 6G e-A
❑ PWS: ❑FC: I
yes / no PNA no ; Crit.Hab. yes no` Closest Maj. Wtr. Body ro�SP-!��
of Project/ Activity
ock) length
m(s) (: ` na -- 5 x IC
pier(s)
ength
umber
adl'.Riprap length ()
✓g distance offshore -—
iax distance offshore
:hannel
jbic yards
imp
'use/ Boatlift
Bulldozing
AL
ne Length
not sure yesfno
gs: not sure yes
irium: n/a yes
yes
Attached: yes no
......
—
_
r -
/ Gig Lv�
ling permit may be required by: _ �/ '� LAUA ❑ See note on back regarding River Basin
I A n 11

DIVISION OF COASTAL MANAGEMENT
AAJACENJ RIPARIAN PROPERTY OWNER IMQIIEICATION FOR11�
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
1 Hereby oertlly that I own property 44went to L0917/14 &n'1 �-I�_'s
(Dame of Property Owner)
(Address, Lot, Block, Road, etc,
on h � � in l N.G.
(Waterbody) (City/Town andlor County)
Agent's Name #It `�� _ Maifirg Address:
Agents phone #: 6-u-o%,- �� C• F_.,� l i/ r, % Y�'
HelShe has described o me as shown below the development helshe is proposing atthat location,
and I have no objections to the proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(kxNvidual proposing developn w►t most N In description below or attach a site drawing)
.e
If you hive objections to what is baing proposed, you roust notify the Dh4slon of Coestal AranagwneW
MM In writing within 10 deys of racelpt of tWO notice. Contact Information for DCU aft" Is
available .at www i_dcmJ*n or by calft 1-8884RCOAST. No
response is 2onsld6md tfre same as no obiectlon If You have been notiiled by Certihad Map.
(Property Owner information)
$igrraGrretl
72-ar4 ►�
Print or Type Name
II(o4t�+h401 063�uj
Iirallind AdaNess —�
parian Propertyr If ation)
4VXA-'��
Jl S• ire
�WM MN'q Pp'rnry-)
lfint or Type Name
�/ � aka t�usSc t� lid.
MaN
W Aches

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER JJQJIEICATION FORA
CERTIFIED MAIL - RETURN RECEIPT REOUESTED
I hereby cerli y that t own property adjacent to L09111494AI M 's
(Name of Property Owner)
property located at Z,(/ ) fQ �G
(Address, Lot, Block, Road,7;�
on h RIf� �, n N.G.
(Waterbody) y (CitylTown and/or County)
Agent's Name # � i _ Maftg Address:
Agent's phone #: h dfI- C,
Het/She has desedbedto me as shown below the development he/she is proposing at that loc n,
and 1 have no objections to the proposal.
DESCRIPTION ANDIOR. DRAWING OF PROPOSED DEVELOPMENT
(hx9 idual proposing development must flfl In description below or attach a site drawing)
w you hiwe o %cNons to what is beMg proposed, you must notlly the Dhrtsllon of Coastal M.anngemerrt
(DC" In wr ttng wNifn 10 days of receipt of this notice. Contact lnfomnilon for DCU offloes Is
available at www.n L*mJ*n or by calf V 1.8884RCOAST. No
response is conaidergd the same as no obMtIon n you have been notified by Certefied Afail.
M, IndiGnTaif
,IRA/aAdd/ess
parian Property Inf ation)
�Q76 B. q M rYl
.,Pdnt or type !Va►ne -
!�/ 6 7a 4 3L ss e I j Rcl
Mating Address

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date y 2e- /3
Name of Property Owner Applying for Permit:
Mailing Address:
v %-
I certify that I have authorized (agent) / ,o,7102, j 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) / Z ) G
This certification is valid thru (date) �—� e , C
f1'
Property Owner Signature Date

cant: �i7 V L G
Permit #: � 16 q!s--
-ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
f in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
3t Name Choose One includes any
anticipated
restoration or
temp impacts)
Dredge ❑ Fill ❑ Both ❑ Other ❑
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or letup
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINALFeet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
' Dredge ❑ Fill ❑ Both ❑ Other �v
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 ❑

INTERNATIONAL MONEY ORDER 75_f
?y Orders
To Validate: Touch the stop sign,
then watch it fade and reappear
- ' ° '
Ad
'ORTANT - SEE BACK 9FFORF CASHING
Q -
x I
AV
w .. _
a
INER FOR WERA R / COMPRADOR, FIRMA DEl LIBRADOR
YOU RfE TO THE SERVICE CHARGE AND.OTHFR TERMS ON THE REVERSE SIDE
`{ y 'I
!DER: ADDRESS / GIFT CERTIFICATE: RECIPIENT
ibl'e Through ISSUER/DRAWER:_?
s Fargo Bank, N.A. MONEYGRAM PAYMENT SYSTEMS, INC.
>ault, MN�
-i f! i i A y ; ;"; I
- j

eat sensitive, red atop sin AND 2. MoneyGrem ima a visible on the other side when held at an angubbed with Coln.
INTERNATIONAL• ORDER
►y Orders
To Validate: Touch the stop sign,
then watch it fade and reappear `
DR]ANTI-SEE BACKWORE CASHING
O/
]HER FOR DRAlIBRADOR
YOU AGREE TO THE SERVICE CHARGE AND OTHER TERMS ONTHE REVERSE SIDI
r.J,' [ U14
RDER ADDRESS / GIFT CERTIFICATE: RECIPIENT
able Through ISSUER/DRAWER:
Its Fargo Bank, N.A. MONEYGRAM PAYMENT SYSTEMS, INC.
ibault, MN