60742D - Makdad

'bCAMA / C DF4IEDGL & FILL ye", NO. 60
GENERAL PERMIT Previous permit #
"ew LIModification Complete Reissue ❑Partial Reissue Date previous permit issued
orized 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
ules attached.
Lint Name Project Location: County
s '1?? 1 PAtM2 Pg V W • Street Address/ State Road/ Lot #(s)
,�yl�ENC stated ziP 13z
# (4�0 p _SS , Fax # ( ) Subdivision 'n
ized Agent PAWQY ffOS[-�1(`.�1t-1-Ik�% kAZI�►' City �'lC ( l-/nw� zip L �i
Fj Cw OtW 5 TA f ES ❑LM 7 ` t Phone # ( ) d River Basin
OEA n HHF IH ❑ UBA ❑ N/A
PW S: ❑ FC: "
yes /)ono PNA ( 6e) no Crit.Hab. yes / no Closest Maj. Wtr. Body !ioV ✓ V
:)f Project/ Activity L)036N 7_U F -r't PIS& LX15-nNG
P 0 CK (NXp +IkC1 L 117 j (Scale:
lock) length 1 d �" N J
•m(s)
pier(s)
length
umber
:ad/ Riprap length
vg distance offshore
'iax distance offshore
channel
ubic yards
imp
use/ atli i27�1
ling permit may be required by: Va V— 1 SL- ft-t-J0 ❑ See note on back regarding River Basin
I -- - -- -. -- -- .. - i'(_ , r n . n . r ,, " --I IJ , .7 . , l I , I—AsO� M

4pplicant: 7 e NclU� 7
)ate: —7/3/f Z
Permit #:'74-Z
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
isturbance total
abitat Name DISTURB TYPEI'Pmn
disturbance.
Disturbance
disturbance.
Choose Oneincludes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
I
restoration or
and/or temp
restoration or
temp impact
impacts)
impact amount)
temp impacts)
amount)
C) W I Dredge ❑ Fill ❑ Both ❑ Other el 10 q— I I u+ I I
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:
P,""d- j
�)&Y,
A//
A.
B. Received by (Printed Name)
❑ Agent
C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
Gfee-rs 0. a Type
WCertified Mail ❑ Express Mail
C:27yoS ❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service labeq 7012 3050 0000 3229 0332
nc r _ nn4 . _.
.-� rurrn oo i i , t-eoruary 2004 Domestic Return Receipt
102595-02-M-1540 ;
Dredge ❑ Fill ❑ Both ❑ Other ❑
i
Dredge ❑ Fill ❑ Both 0 Other ❑

Bank of America
ACH R/T 053000196
INTRACTORS, LLC 08-03
i7-2159
OLD CT.
D, NC 28443
5801
66-19/530 NC
58754
!7
0
N
DOLLARS
5
LL
r _.--.._.....,_.._.. LITHO IZEO SIGN RE
80 Lu■ IM S 3000 L961: 000681, 74 3 7 38ii' _ a

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CM

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
i
Address of Property: -35� 5
I (Lot or Street #, Street or Road, City & County)
Agent's Name #:�/r"� ��+'��`�� Mailing Address: �7ar�� 61
Agent's phone #:0'�3�'
I hereby certify that 1 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 must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
u 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. Contact information for DCM offices is
available at_j-uwt4nccoastairnanage:°,-ie,,7Lneilcoiiiac�- or by calling 1-888-4RCOAST. 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, lift, or groin 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.)
I do wish to waive the 15' setback requirement.
%/T-� G I do not wish to waive the 15' setback requirement.
(Property Owner Informatio )
Signature
Print or 77ype Name
�123 Z-11y,,.
\\((A\dja�,ceent Proopperty///OJ�wner formation)
yjc5l,,�uct JV bzu)L
Print or Type Name
quo ( C Ntl�-:Qu `t E
Mailim Arkirpcc

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date A p% � 2. 3.1 2.C>( 3
Name of Property Owner Applying for Permit:
Ter,encn" A. MatkAnA
Mailing Address:
I certify that I have authorized (agent) N\ ti4 Tf\ar'l nQ- C-04rOIQ. o f5 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) MOA 1 �kr o}ionS E.X► S� In� �Iet'�d ,
at (my property located at) 3 �- L • io�1 D ', , �k �S�Q� , iJ C. �8�(0,
This certification is valid thru (date) � I � ao ( 3
0-1�1 � -u.%
I --- - am LJ

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You entered: 70123050000032290332
Status: Delivered
Your item was delivered at 1:36 pm on May 20, 2013 in GREENSBORO, NC 27405.
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