57459D - Hazel

J CAMA / DREDGE & FILL ^
E N E RAL PERMIT �' Previous permit #
New -,Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources —7 Z O v
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
t Rules attached.
itName �} [MA �� AZE 1 Project Location: County t 4b%li
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Fax # ()
zed Agent
❑ CW -7 EW i j PTA ES ❑ PTS
❑ OEA D HHF - lH - UBA ❑ N/A
❑ PWS: ❑ FC:
if Project/ Activity
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP 2
Phone # () River Basin
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Closest Maj. Wtr. Body ST t/ ru P SUy N
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ing permit may be required by: o"Lr � ❑ See note on back regarding
tRiver Basin

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)�L6-69-2912 29.48 Fram:
To: 93c941E1
I hereby ceftfY that I own pmpedy adjacent b A it {i s
Droperty iocstod at . (NOW of dy CWndkr)Y
Adtfe I.a t31oc(� am
R d. d �-
on r
Oo
(Vifatorboegry tC owzt andfor
P.112
.The Applicant has da=lbad to me, as ehornm below, the developmant proposed at th5 abava loeetion.
l tam no objection to this propusai.
i have otrjectlons to this proposal.
WSMPTM AND/OP DRAWWO CP PROPMD DEVELOPMENT
(h4WJ"(PMpaslh9 detrelopmwd musf 131E In desodlpt" below or attach a site anwIM)
I underetartd that a pier, dock, mooring Pitfngs, brawcw tar, boathouse, M, or groin must be set back a
nVr4m= di dance of 15 from my area of riparian accods untosa waihmd by me, pt You wish to weW
Um PAbaek, Yost aarst it 02f the apptopg to blank below.)
t do twiah to waive the tti` ctibact: regtdratn�[t
._,.w,_,", ! des not wiilh to w1 hro the i 5' setback regWmmonL

A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Dee Frei
Governor Seci
AGENT AUTHORIZATION FORM
Date: (' "
lame of Property Ow er Applying for Permit: Name of Authorized Agent for this project:
►wner's Mailing Address:
Agent's Mailing Address:
011.E )�? Y
1�� e,�( � .. PT . 21 iv?s
hone Number( ) Phone Number (j6i�r rlf 'f/jf
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
ny property located) at
his certification is valid thru (date)

'cant: �td �1
- _ .Permit #: C5 �u
-ibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
f in your Habitat code sheet.
DISTURB TYPE
at Name Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impact)
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)
l
W 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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

■ 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:
2. Article Number
(Transfer from service iabeq
PS Form 3811, February 2004
A. Signature nn
X Bank of America Home Loa Agent
uu Addressee
B. ReceRkdbl MAW%k4 C. Date of Delivery
Plano, TX 75024
D. Is delivery address different from item 1? ❑ Yes
If YES, enter 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
7010 1060 0001 4608 3276
Domestic Return Receipt 102595-02-M-1540
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