57593D - Apple

- CAMA / DREDGE & FILL
3"ENERAL PERMIT Previous permit#
New Modification I (Complete Reissue -Partial Reissue Date previous permit issued
wized 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�
Rules attnrhed
it Name Ira rYu > A , , i G
State—"- ZIP L cAzi-3
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zed Agent Al c V 1- h y- 1
I ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
OEA HHF AH ❑ USA ❑ N/A
PWS: ❑FC:
yes / no PNA yes / no Crit.Hab. yes / no
d Project/ Activity � ,t ; VL
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Project Location: County ErunSwir
Street Address/ State Road/ Lot #(s)
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Subdivision N/A
City Cera�' j k F-54'a' ZIP
Phone # (110 ) Y42-3 ZS River Basin LVrvi
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ing permit may be required by: . ; I . ❑ See note on back regarding River Basin r

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner: JL =It
Address of Property: 0i /J/yt/r4 /G.-, Sf'
(Lot or Street #, Street or Road, City & County)
Applicant phone S 3/ / .J Mailing Address: %/ Cl•°t ClG ayes
ro to mba:, S'C 2 l ,-U3
I hereby certify that I 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.
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.nccoastalmangement.nettcontact 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.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
waive ts�e setback, you must initial the appropriate blank below.)
If L�J I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
riVature o
Print or Type Name
/'% 9q i, rC l irc li✓a h
Mailing Address
(Riparian Property Owner Information)
Print or Type Name
�Z 0�
Mailing Address /

R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue ,lames H. Grew Dee freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Owner' Mailing Address: Agent's Mailing Address:
�/�m i sc ay�3 0 c_-grA Ik 2��9
o �a5 / ��
Phone Number (O. . /. - i]U � Phone fVumber (��) }? i
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to Install or construct the following (activity):
ec —
(my property located) at n q %
This certification is valid thru (date)
1.2A hl _. _ i
Prop"mer Signature Date
127 Cad al Dft Ea., wkkOon. NC 26405 Not ttiCarolin a
Phone: 910-796•ilrs 1 fA) O-M-3964 ,�na: W*W-r ahmrkVOrll eLrmt Nd iCaR'«if
MEWdoppoe tAlia�eMwbrOWU

C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: 1 t7Af f u Permit #: ��13
te:
�2
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.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
)itat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excludes any
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts
impact'taamoouunt)
temp impacts)
amount
f - 1
W
Dredge ❑ Fill ❑ Both ❑ Other
Z�
Z O
Dredge ❑ Fill ❑ Both ❑ Other ❑
COMPLETE•N COMPLETE THIS SECTIONON DELIVERY
■ Complete Items 1, 2, and 3. Also complete A. Signature
Item 4 If Restricted Delivery Is desired. ❑Agent
■ Print your name and address on the reverse dressee
so that we can return the card to you. B. Received by r C. Date of Detively
■ Attach this card to the back of the maiipiece, S� t
or on the front if space permits.
D. Is delivery a ress ant It �� ❑ Yes
1. Article Addressed to: If YES, ante deliv I ❑ No
_--
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Nc' Z ).6 y
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 1 7 010 3090 0001 1219 4567
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

MARITIME BUILDERS, INC. 12-06
1957 STONE BALLAST WAY SW
OCEAN ISLE BEACH, NC 28469-6537
PAY A/C -
TO THE / V ORDER OF
Bank of America "�j
ACH R/T 053000196 ���
4.JJ1144.✓✓J, ��
2279
DATE Z �30 66-19330NC
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O L L A R S
FOR
11000 2 2 7 9u' l:0 5 3000 19 6l' v
2 3 7000 58 6 38 411