61542D - Sprinkle

'AMA / El DREDGE & FILL uF -SIV-
ENERAL PERMIT 6 Previous permit # 5 -735,
Jew ❑Modification Complete Reissue ❑Partial Reissue Date previous permit issued
.ed by the State of North Carolina, Department of Environment and Natural Resources �i� Z
astal Resources Commission in an area of environmental concern pursuant to I SA NCAC �d
%/
mules attached.
Narm�e 5jar i rt kt° Project Location: County / 16;
Street Address/ State Road/ Lot #(s)
h State ZIP %�'' —so%�S�AlQ�, /�•
Gi11�) -264 Fax # ( ) Subdivision /�" �� �U � / 'n5
I Agent City jo f ' 17irar j-, ZIP Z ,
❑ CW
LtW QPTA
❑ OEA
❑ HHF ❑ IH
❑ PWS:
❑FC:
;s / no
PNA �o
Iroject/ Activity
length
,th
ber
Riprap length
listance offshore
distance offshore
nnel
V Boatlift
Length
not sure yesicp
not sure yes r
m: n/a yes
yes n
tached: yes
❑ ES ❑ PTS
C UBA ❑ N/A
Crit.Hab. yes / no
Phone # ( ) River Basin 11154
Adj. Wtr. Body /11/4 nat r
Closest Maj. Wtr. Body- �.r' �
3 permit may be required by: �% � • L A ❑ See note on back regarding River Basin r

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date a - d - / 3
Name of Property Owner Applying for Permit:
l IDaVe-e 5ign&-Ue-
Mailing Address:
r-
I certify that I have authorized (agent) a- / to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 12 f, J(-Ze- ),-�-Ieep� , /h13 c e;&-k-
�a�� ,
at (my property located at) -AlZj;1 ✓�
This certification is valid thru (date)
IZ-31-)3
Property Owner Signature Date

C Division of Coastal Mgt. Habitat Impact Computer Sheet
)plicant: bqv,,e/ S"�rf� /` /-" Permit�Z-
ite: 3 `? /2,:P/3
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat Name
(4
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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount
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 ❑

3 W.'jdiP r#A7.r
Bank of America 5643
ACH R/T 053000196 66-19/530 NC
WARINE CONTRACTORS, LLC 08-03 58754
910-367-2159
92 HAROLD CT. y
HAMPSTEAD, NC 28443 - [
DOLLARS u

■ Complete items 1, 2, and 3. Also complete A. S' ature
item 4 if Restricted Delivery is desired. X
■ Print your name and address on the reverse
so that we can return the card to you. [yBtb
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
C it" /lu, (3 , 6,,,,,706,t l / ZIP
/, ro v, (oN k.0
a7(o4
D. Is
If
MAR 072013
iY❑Ye
❑ Ni
NC
3. Service Type
Certified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(transfer from service label) 7 012 1640 0 0 0 0 1119 4 7 91
PS Form 3811, February 2004 Domestic Return Receipt 102e95-02-M-1540
* 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 ma'1p' �
or on the front if space permits. n/ "L " ,, l`
1. Article Addressed to:
`? rg
Al Z �S
A.X SI turec�%�'-eJ�
❑ Agent
Addre
B. Received 0 (Printed Name) C„Pate of,Dell
ery address d) kOrFftCV ff[!Os
rtter "Maddresa tae"T&O �V ,C
MAR 0 7 2013
3 �9ervi pe
e fled Mail ❑Express Mail
I Istered ❑ Return Receipt for Merchandise
Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7 012 1640 0000 1119 4807
_
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-0IM2 sao