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American Fish Company
P.O. Box 11046
Southport, North Carolina 28461
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(910) 457-548,
(910) 457-655

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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
',. icnael F. Easley, Governor James H. Gregson, Director Nliiliam
Authorized Agent Consent Agreement
is hereby authorized :c ac:
(Prih(ed Name of Agent)
in order to obtain any CAMA permit(s) required for the property listed below. The authorization is
specific activities described in the attached sketch.
LOCATION OF PROJECT:
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PROPERTY OWNER MAILING ADDRESS:
Po.r3o�6
AUTHORIZED AGENT MAILING ADDRESS:
S(Ooo oily &iD(e C�D'
A-xPoc4 N c, 21?y(p r
PHONE N0 /O y 30-youf S 1*2
PHONE N0. O►W -UST"►-S LA 8
C./ l SicrYature of Property Owner:
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Name of Individual Applying For Permit: l K.P,- (6f-kk _..
Address of Procerl-v' vJeY} r _
L^t or S'.reet 0, 5 reel or Road?
Cry and County)
? herei y c.rtiiy iint I own, property adjticcnt to the adove•fcferercetf Nrot^,C,""', The Mdividge
Ippiying for this pertric lies descn6ed to me Ls mown on the atxcned drt,wir,6 're developmentteA,
Ire proposing. A rt on or drawing, with dimensions, sho;�id rr3v de°.1 withthts letter
nave no objections }o ?,his propose'.
if , cu have objections to %vllQt is being proposod, plenso write the Di., P.w,r of Coestl
Maoagcment, 127 Cardinal Drivo Extension, 1�4iiimina olt, NC '18405 r)r -_,l1 Yi _•796-711:
within 10 days of receipt of this notice. No ruponse is considered the samc as flu object'ioni
you hate bee,, notiNd b� Cerr,rled MaiL
WAIVEn SECTION
i understand that n pier, dock, mooring pilings,bronicrvater, nowt hoase or boa: !;I, mustbe-s,
�,k a rninlmum distance of I5' from my area of riparian :;Loess - unless me (ifyo
'.�ish to ��aive +`,e setbock, you must initial the appropriate binrk
Aisn to',vaive :he setaQk rce+�irt
1
Print `r,me� RMA

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Name of Individual Applying For permit: r Kf.QC-it
.address of Propert�,' vJe5A r.
(Lc. t or S!reet A. 5 ect or Road)
'.Ciry and. County}
i hereivv oeniiy :ha, I own propery adjacent to the above. rtferer.ced prope:Ty. The individw
applying fot this permit has described tc me as shown on the awche;i drawing tne. (evelopmenxfx
are propo>ing• A ccscript'on or drawing, with dimensions, shouid tte r_rovide,-, w►thlj% letter
—Qt" 1 have no objections to Th.s p700osn.
ft' you have objections to what is being proposod, piease ��rire the' Ui�of Coast
Management, 127 Cardinal Drivo Extension, Wilminb on, -NC 28405 or c:ril `'lJ-79d 711
wirbin 10 days of receipt of this notice. No response is considered the same as M) Gojecri h
%-ou hcve bee:i notified b�, Certified Mail,
WAIVER SFCT.YO,�'
I understand that 7 pier, dock, woring pilings, brenlovater, bw. housc or boa, iiit muStbe:
bc'?%'a minimum distance of 13' from my area or riparian acccss - unless me, City,
wisp to wzive ,I1e setback, you must initial the appropriate biovi; be►a\t
do wiSn to waive the i j' s?'buck rent=i`�"
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Americ Fish mp ny
PO Box 11046
J� "nuthpoo North Carolina 28461 +NVOICE NO it
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Name of Individual Applying For Permit:.La<t g2�I
Address of Property:-40��NN &,
rLot or Street 0, Street or Road)
Qa,Y-v a 1"yA icy
(City and County)
hereby certify that I Own property adjacent to the above•referen.ccd propc:�. The ini
appl}'ing for this permit has described to me as shown on the attached drawing tnc dtveiopm
are pronosine. A description or drawing, with dimensions, should be cm -vide:! with this 1
I have no objections to this proposn;
If you have objections to what is being proposod, please write the D1�isi�,n of
Management, 127 Cardinal Drivo Extension, Wilmino on, NC `8405 or e:ril 41 -75
within 10 days of receipt ofthis notice, No response is considered Elie some as no obje
�'ou have been notified by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, bronkrvater, boot mouse or boat sift mu:
bck a minimum distance of 15' from my area of riparian access - unless waived b" me,
wish to woive the setbock, you must initial tho approprinEe blank below„
do wish to waive the 14, setback reouire,,,y�:
I ao not Nish tO wnivC the 1 setbaci:."eUuire
5 N n m e D"ta
Print Name

Division of Coastal Mgt. Habitat Impact Computer Sheet
cant: I(Y\11_t 11SERA, Permit #: 5-7
t/ILl/II
ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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
impactCamm{ouunt
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tempimpacts)amount))
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/o
temp impact
0 Vj
Dredge ❑ Fill El Both El Other �
-/
1 ID v
`�
7
C v``
Dredge ❑ Fill ❑ Both ❑ Other j2/
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 ❑

--- 82828
THE AMERICAN FISH CO.
CHARLES H. OR KAREN Z. PERRY 66-30/531
P.O. BOX 11046 \ ^ 5 ► 1 \ 453
SOUTHPORT, NC 26461 DATE l _1
DOLLARS
First Citizens
Bank ^�
fi�stcltlze�ns.comf`'� �( (.
asna 28 2811, l:0 S 3 L00 300j:00►+ S 3 L 2099 2 2