57451D - McLamb

�CAMA / ODREDGE & FILL M`
GENERAL PERMIT Previous permit # -Q9-
�'New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued TE
Drized 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 7
nt Name Yam' r`' fJ ❑ R I tta hed
State NG ZIP
ized Agent jy �5f
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❑ PWS:
yes no
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❑ FC:
PNA yes is)
of Project/ Activity
p /i't— a
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Crit.Hab. yes
ppu es c
Project Location: County j+%
Street Address/ State Road/ Lot #(s)
7ON6 7 S .
Subdivision
CiZIP
Phone # ( ) �//— , River Basin / G%
Adj. Wtr. Body iWI U G� 1,14-nat
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gs: not sure yes no
wriurn: n/a yes no
yes no
Attached: yes no
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Jing permit may be required by: i 4f---c a ❑ See note on back regarding River Basin

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
V�M y ago- 01,cf.#4�-
10015�4110iCv71 /�p117c-
Owner's Mailing Address:
Agent's Mailing Address:
Phone Number ( 2/ %M — -2 Z,,I/ Phone Number(/y)
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at
This certification is valid thru (date)

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to /rI Le�� 4 's
TT (Name of Propert�r Owner)
property located at V z
7
Address, Lot, Block, Road, etc
on in N.C.
( aterbody (Town and/or C nty) C
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Print or Type Name /
9
Telephone Num r
.- z z
Date

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR LAMA MINOR PERMITS
I hereby certify that I own property adjacent to 1"c::s
7 (Name of Property Ownor)
property located at / 0i)
Address, Lot, Block, Road, etc.)
on in i .:= C.,r C�,Gc�y.-f N.0
(Waterbody) (Town an�unty)
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no object ons to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED
X144/14y"Ir
Si lure
,J a Yi L.
PrinType or Name
�;9--153- 7,-tyo
Telephone dumber
Date

as
-ST OW&L XMrs-Moso North American Banking Company, MN
N@M,my ORDER 3 2 8 2 5 2 6 0 5
C—CHECK #1 M.O,#328252605
6432 02/27/13
r,,�4C30,D0LS01C]CTS
FOUR HUNDRED AND 00/100 DOLLARS
NOT VALID OVER FIVE HUNDRED DOLLARS $500.00
— SHIER READ REVERSE SIDE DEFDRE CAS G lV��rr�
1 oar. oaoE. >r"i L h,&i 11,gV. lrti �.�'1,a 1 D
r c nets nooasss

Acant: S � ��t'rh �j
Permit #:
:e:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat Name DISTURB TYPE
Choose One
TOTAL Sq. Ft. FINAL Sq. Ft.
(Applied for. (Anticipated final
Disturbance total disturbance.
includes any Excludes any
anticipated restoration
restoration or and/or temp
temp impacts) impact amount)
TOTAL Feet FINAL Feet
(Applied for. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
16— 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 ❑