62690D - McCuiston

NC Division of Coastal M, 9t, Habitat impact Computer Sheet
applicant:
Date:
Permit #: C ail o l
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
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 fina
disturbance.
Excludes any
restoration and/
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Others'
1 ��
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other TE01
Dredge ❑ Fill El Both El 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 0

TINE CONSTRUCTION I 1106
PO BOX 1417 66-112/531
MILILLE BEACH, NC 28480
PH 910-754-9740
DATE
BANKING AND TRUST COMPANY
800-BANK BBT BBT.Com
00 l 106ii' i:0 5 3 LO 1 1 2 0: 134000 1 l0 7 5 3 311'

40 ONP

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
McCrory Braxton C. Davis John E. Skvarla,
wemor
Director Secretary
AGENT AUTHORIZATION FORM
Date: Z v
ie of Property Owner Applying for PerLmit: Name of Authorized Agent for is project:
ier's Mailing Address:
ine Number 6iL E q Z 8 / 0 -7
Agent's Mailing Address:
/?0.Ao/1ill 7
Phone Number (WO ) M/ LSy3 R
rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at
s certification is valid thru (date)
Properly Ovrer Signature
1 20
Date

Dzrozi17
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OVA'NER NOTIFICATION/ FORM
Name of Individual Applying For Permit: M o a k �� 0, U i S -k6 n
Address of Property: `p 8 q -S�-A EX I( el V D
(Lot or Street #, Street or Road)
and County)
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, should
be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please call Debbie Wilson with the
Division of Coastal Management, 127 Cardinal Drive Extension, Wilmington, NC
28405 or call 910-796-7215 within 10 days of the receipt of this notice. 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, moorings pilings, breakwater, boat house or boat lift
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
bla elow.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
9.1

zrot/V
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY Ou'NER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: A' 1 Ate 1 �- lit ► S �o t�
'
Address of Property: �2'9 G
P Y�
(Lot or Street #, Street or Road)
zC? �(2z
(City and County)
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, should
be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please call Debbie Wilson with the
Division of Coastal Management, 127 Cardinal Drive Extension, Wilmington, NC
28405 or call 910-796-7215 within 10 days of the receipt of this notice. 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, moorings pilings, break -water, boat house or boat lift
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.),
- _5 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.

eA
Ix
0/1-27" Dock