59556D - McCraw

■\'kl-l■■ 1.■■■■:'■■■■■:■■■■\■\�
■■1■■■ I ■■Mit t AA■■■ ii`i■\■I►���!

yY,,»q
J,P�)'�,S �Vo �Cr
-7)-V77 /-,I _ W

QUA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date C ✓ I O 0—
Name of Property Owner Applying for Permit:
l 14& 6ra- (Aj
Mailing Address:
-611 OY-444 r`rc- �"e-
Owe( #7` ."VC a 7517
I certify that I have authorized (agent) /& c P.« /�&d to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) dOG�-' ,
at (my property located at) / y 5 SJ 1
This certification is valid thru (date) 3 Z
Property Owner Signature Date

ADJACENT RIPARIAN PROPER71 Y OWNER STATEMENT
(FOIE A PIERIMOORBVG PILINGS/POATLIF'TIBOATHOUSE)
I hexeby certify that I own property adjacent to A R /-;t �`s
(Name of Property Owner)
property located at
/08 52, q✓ // G-/-
Block, Road, etc.)
on �5�,��PD 6-eeA , in IC 6 '1-Y N-C-
(Waterbody) (Town andlor County)
Applicant's phone #:
Mailing Address: Dx�QS�,,,�
�� aver fh% ,tre- Z 7si 7
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 most initial the appropriate blank
below.)
I do Hot wish to waive
1 do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fd- kd in by individual proposing developnwnt)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature
LA W5,r fX ( V, t_%- L;. oy ?o 0 13c= 1 I-, —�—
City/State/Zip Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PIL NGS/EOATUTTI tOATHOUSE)
I hereby certify that I own property adjacent to %< 2 /�?L C 1-4
(Name of Property Owner)
propert�i located at / V g
on /S/uq e DalL5 Creel-
(Waterbody)
Applicant's phone #•
S,e,el- % / // C 1'�- ,
(Lot, tdock, Road, etc.)
`s
in �j .� r J�c 61 �x N.C.
(Town and/or County)
Mailing Address:
8/,/ Ox k,,,(5X, )re-
L �^ .
Cti.qpC-/ 76-17
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 / boadift / boathouse
must be set back a minimum distance of fifteen feet (l 5) 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
1 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)
Mailing Address
City/State/Zip
(Riparian Property Owner Information)
r, 7 7 1 / � c
- � ��
Signatures
Print or Type Name

)Ilc&t: V1 Y (—eTt / C �� G !
Permit #: S75-5-6
e: / -3 / —(Z
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
itat Name
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)
'- II
W
Dredge ❑ Fill ❑ Both ❑ Othe
Dredge ❑ Fill ❑ Both ❑ Othe
Z(�
Z ��
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 ❑

ALLIED MARINE CONTRACTORS, LLC 08
910-367-2159 -03
92 HAROLD CT.
HAMPSTEAD, NC 28443
PAYTHE
ORDER OF
MEMO GGr�c✓� orr"', RYZ
lie 0O4B 7011
2 I:O 5 3000 196i:
Bank of America
ACH R/T 053000196
0 0 0 6 8 4? 4 3? 3 8 ��� AUTHORI,

Bank of America
ACH R/T 053000196
ALLIED MARINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443
PAY TO THE
ORDER OF W (9
4 " -�' {'ll-� '0 �C
Li P 5 P15�5, C, P5'7�(, G P5 7557
/►/
MEMO CL c✓ /
AUTHORIZED SIGNATUR
11800487011' l:053000 L961: 00068474373811'