57599D - Elliott

l
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
leverly Eaves Perdue James H. Gregson
governor Director
Dee Freemai
Secretar
AGENT AUTHORIZATION FORM
Date: i i2
ame of Property Owner Applying for Permit: N e of Authorized Agent for this project:
C,
wner's Mailing Address:
Agent's Mailing Address:
3-3
O
hone Number C26) 3 -/ l Phone Number
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
rr and obtaining all CAMA Permits necessary to install or construct the following (activity):
„y property located) at (lti
his certification is id thru (d e)
Property Ow signature
Date

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PMRIMOORNG PLUNGS/BOA7U19 B0AT4r0USE)
I hereby certify that I own property adjacent to / S4k 1 `s
(Name -of Prope-iy Owner)
Pro1erty 1ocated at _ 30ya000 srop r
(Lot, Block, Road, etc.)
on t-Anl AL , in OGf-AN TS(IL �SEwC.l4 , N.C.
(wady) (Town and/or County)
I
Applicant's phone if: 419 - "I -1411 Mailing Address:_ l&e EM!!t6 OEnov- ?-Ap
509 CJ1'5 2.75 (
He has desm'bed to me, as shown below, the development he is Proposing. 1 at that location, and, I
have no objections to his proposal. I understand that a piertmooring pt / boatlift I boathouse
must be set back a minimum distance of fifteen feet (1 S1 from my area of riparian access unless
waived by me. (if you wish to waive the setback, you most initial the appropriate blank
below_) I
-1-� , I do not wish to waive
I do wish to waive that setback requirement
DESCRIMON AND/OR DRAWING OF PROPOSED D PMENT:
(To befilled in by in&Wdmal proposing dew&.
(information for Property Owner Applying (Riparian Property gwner Ulormation)
for Permit)
110 �Atiit/+S Qsr �2olZ —
Mailing Address'
Sienature
5449 C_In ivy 2_7311q P14ft)P #A Y fwols

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOAf4OUSE)
I hereby certify that I own property adjacent to _FKF-m i �-LLI0 ma's
(Name of Property Owner)
property located at 30 V N i o tJ 5-na _I -
(Lot, Block, Road, etc.)
on GANRL _ , in. 0Ct-4N Z5GF- 115 4GFF , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: ci 19 - &Gz, - q1J Mailing Address:Pgo FAM4 121E�K- PvA!
51( Q GrTy f N Z? i 4g
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
�/
-- I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
A FAI'd,45 sr ROAD
Mailing Address
-------- --------------------------------- I ----------------
(Riparian Propertv Owner Information)
a
Signature
51V-A c tom, C.- Z7SLA(

30 04104 sort
\10
a
f
q *

US MAIL
CERTIFIED MAIL, — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJAC rT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: _N� C, !ALL / 07
Address of Property: _ (� U/� �VV `7� , (�(� �N �5( 6(— (—N A
(Lot or Street <Street or Road, City & County)
Applicant's phone #: Nb) A2 — 1)qQ _ Mailing Address: F, — s
s1L-Ek G�NL 27�yy --
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permi
has described to me as shown on the attached drawing the development t ey are proposing. A description of drawing
with dimensions, must be Provided with this letter.
I have no objections to this proposal. �.I have objections to this proposal.
If you 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. Correspondence should be mailed to 127 Cardinal Drive Ex1
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no obieetion if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance o.
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.)
K' RECEIVED
I do wish to waive the 15' set back requirement. DCM WILMINGTON, I
{r I do not wish to waive the 15' set back requirement. AUG 2 2 2011
(Property Owner
Signature
90--Vs- C. FLL/ar
Print or Type Name
-.,� FAU/Ns 9&5S- da p
Mailing Address
Sig �-2 Lr, Luc
(Riparian Property Owner Information)
Signatu e
t! P f�Al�J.4 & T�PD,O 6
Print or Type Name
2720 Clay ,1// r
Mailing Address
6q,4hV7T, AlG 2921Z'

a
w

y Division of Coastal Mgt. Habitat Impact Computer Sheet
Acant: j3y-t4l� C 9)uc 6.� Permit #
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
Ui
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)
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WILLIAM DEREK EDWARDS 05/10
33 RAEFORD ST.
OCEAN ISLE BEACH, NC 28469
FAY THE
ORDERER OF N J '✓
RBC Bank'"
• : J��s D �e;: "sqc/ b
MEMO i. �� /(�KD /
-1:0531008Sol: 10330 L
66-85/531
DATE ! ° 19 - / Z
2 5 7 LII0 L084
1084
DOLLARS L)
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