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■ Complele items f, 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
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C�a Qc�rlr�
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❑ Agent
❑ Addressee
/ L�vr y� 5P red N /
C.� ate o{ ` livery
Is delivery address different from Rem 1?� ❑ Ye;
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) 11 Yes

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Jame of Property Owner: ( I y �j & 11
Address of Property: 71 Q6
�4� (Lot or Street #, Street or Road, City & County)
Applicant's phone #: )) �o� 3d'o� S�y Mailing Address: /a s 4/W "iL
-'/ 6��dL iS/'-11 1zle- a 51Y6s
hereby certify that I own property adjacent to the above referenced property. The individual applying for this p
ias described to me as shown on the attached drawing the development they are proposing. A description of dra
vith dimensions, must be orovided with this letter.
I have no objections to this proposal. I have objections to this proposal.
f you have objections to what is being proposed, you must notify the Division of Coastal Management (DC
n writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
7Vilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response i
!onsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distant
5' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
ppropriateJAank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
Property Owne Information)
>ignature
B
'rint or Type Name
63Q S lln"k- G,. ®J
(Riparian Property Owner Information)
Signature
%j S.1:•"`,11(
Print or Type Name
1, A
✓failing Address Mailing Address

CERTIFIED MAIL — RETURN RECEIPT REQUESTEDE C E I V E
DIVISION OF COASTAL MANAGEMENT MAR 0 9 Nil
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
D. C
Name of Property Owner: &Or, &� REG. WILM. FL
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: Mailing Address: (4'13Z A,Le)�,
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this I
has described to me as shown on the attached drawing the development they are proposing. A description of do
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 (D(
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drivi
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response
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 distan
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial th
appropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signature
Print or Type Name
ce I s Mil-fk- 6e?%c.
Mailing Address
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address

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641 R�J� �►���y
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ArcIMS Viewer Page 1 of
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•
Division of Coastal Mgt. Habitat Impact Computer Sheet
icant: j* Permit #: W-54Z
11R1Vt�
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d 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/o
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other I
Lf ��
V
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 0

4y
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Bank of America
ACH R/T 053000196
.IED MARINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443
,V/�
AUTHORIZE IGNATURE
001131,7110 1:0 5 3000 19 61: 000 68 4 7 4 3 7 38
4347
A19/530 C
0I2 mor
DOLLARS [2

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
Name of Property Owner Ap lying for Permit:
8,q,A
Mailing Address: n '
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) fj & l j 4
at (my property located at)
REk;k=l'V k=U
DCM WILMINGTON, I(
This certification is valid thru (date) _-5 MAR 2 3 2011
Property Owner Signature
Date