59141D - Masonboro

/ s f
CAMA / A DREDGE & FILL
iENERAL PERMIT
flew i❑Modification El Complete Reissue ❑Partial Reissue
Tdy 1191
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / . d
Rules attached.
Name / •KSA'� �Ot© /ivcd/f
41, � k4 t'mg J_ StatwVe- ZIP ZgYe4
Fax:# ('�
LH
or
:d Agent A4f ICc* A'r ✓�t6i /i n
C CW J1 EW feOTA C�S ❑ PTS
C OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Project Location: County
Street Address/ State Road/ Lot #(s)
S6 25 Ce*d 1w /), s 1ea�.e- .
Subdivision�
City '1/ I,I t'rt%H�i� ZIP �l
Phone # ( ),G r River Basin Z4 l
Adj. Wtr. Body Yt,,� t �✓V at
yes no PNA / no Crit.Hab. yes / no Closest Maj. Wtr. Body 1�5dh 4Qr6' 'ice
Project/ Activity l / /�/� 'w /27,d"�
C✓S� ✓hA,-,nA kx,51A L)ICe-SS rl,4,7~ 1 (Scale:
ng permit may be required by: NA ❑ See note on back regarding River Basin r
rrti /_ - —] .J 1 !'r.,., � — ._ ). .

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 2 2
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) �itYvl����1�%U .'Ns�' �.v to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Property Owner Signature Date

wl!5, "
f1k.
�o I
75
s-L r
6,
161
Fx
Z7-0, -Dcx 4,y zo t P,,,e r
I.
6 Lk CP"
75,x
78%

MASONBORO HOA - (c/o: M.B. Conard, Agent) - (NH)
5625 Captains Lane, Masonboro Landing, Wilm., NC 28409
_Mairs
a
' CERTIFIED MAILT�, RECEIPT
Er
Provided)17- (Domestic Mail Only; No Insurance Coverage
ru
For delivery information visit our website at www.usps.com,@
rv_v
CO
Postage $ ,
p Certified Fee
p Postmark tw
p Return Reciept Fee Here rn
(Endorsement Requ red)
0 Restricted Delivery Fee
,Endorsement Required) y �
ru
Total Postage 6 Fees
ru
C3 Sent To
r,
�treet, Wit. .;
or PO Box No.
------------------=---..."!..._:Je 1.., fvy----------------
city. state, ZIPr4
b'A n, VC
PS Form :i0 June 2002
1 ■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
ul ' so that we can return the card to you.
m ■ Attach this card to the back of the mailpiece,
m or on the front if space permits.
p 1 .Article Addressed to:
CO
m m nn Sir L. + v err, /�- A A%
A. Sig
B., Received by
NEW
Name) I C. DaJfe of
D. Is delivery address different from item 1? 9,U Yes
If YES, enter delivery address below: ❑ No
(End l�1-)) L l74-1'Vi n

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to -"0.,6,C fXi;'s
(Name of Property Owner)
property located at :L2 (_ l,"/ys L'+
(Address, Lot, Block, Road, etc.)
on %c1taJ in � 1 �&-I �r}�✓£, i/'
- - _ _ 1 � . N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: Mailing Address: .36Q0 -G'
Agent's phone #: �`I q) kf 70 --66 / p
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Su 4 Ala
rnwwA*xc--44 "D1"Arf, —���e�
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. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail. _
(Propert O r Inf atiq r' (Riparian Property Owner Information)
gnaturO Signature
Print or Type Name .1
1
Maili dr s
City/State2ip
4/J ) 79 ( 76 l
Print or Type Name
Mailing Address
City/State/Zip
TA/onhA— Ah—h— 1 Toh i hh,., ;—

to vllvcslon 07 uoastai Mgt. Habitat impact Computer Sheet
plicant:. 450k7 Leal � &41 Permit #:
sl / x/
te:
2 %Z 7_0 Z
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft.
(Applied for.
Oat Name DISTURB TYPE Disturbance total
Choose One 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 IFill ❑ Both ❑ Other ❑
330
4G Dredge ❑ Fill Both ElOther ❑
i CEO
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 ❑

-- - -- FOR SECURITY PURPOSES, THE BORDER OF THIS DOCUMENT CONTAINS MICROPRINTING
►ROLINA MARINE CONSTRUCTION, INC.
Ph: 910-793-4143
3600-E South College Road, PMB 326
Wilmington, NC 28412
DATE —
---66-4 — I
ot
- o
FIRST BANK _ -
WILMINGTON, INC
Y
i,/p_/}�'�� �O �(�1/j �j/l✓�� �`71IY( AUTHORIZED SIGNATURE
II■00737 L11' i:053 LOL.5618i: 199000 2 L L?"o