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From: "Karen Valentine" <[e-mail]>
Subject: Agent Consent Agreement for Boca Bay
Date: October 18, 2011 5:05:58 PM EDT
To: <scarter0l @windstream.nefl
1 Attachment, 300 KB Save • Slides how
Per our conversation, please sign and return as soon as possible. Thank you.
Dan Valentine
910.471.5849 cell
910.270.0128 home
k—[e-mail]
AIFix
NCDENR
North Carolina Departmert of Envi, onr.ent and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Jades H. Gregson, Director ATlian G. Ross Jr., Secretary
Authorized Agent Consent Agreement
is hereby au:hcnzed tc act cn rry behalf
(Printed Name of A.-ef
in order to obtain any CANIA permit(s) required for the property listed be!ow. The authcrizatcn is limited tc the
speck activities described in the attached sketch.
LOCATION OF PROJECT:
Bror� &W •
PROPERTY OWNER MAILING ADDRESS:
y nn (.C,l J. Co-r Tcr
x I-3a 1 %eraker- 7r-a: l
VCln T Ne o7T.33� __ PHONENO.,',- �%"� 776-0343
AUTHOR17FD AGENT MAILING OnnRFSS.

PHONE NO. 9IG7 — Lt7l � !Z
Signature of Propery Owner:
Signature of Authorized Agenl
Da
127 Cardinai Cme Ext. Wilmington, North Carolina 28405.3845
Phone: [phone] FAX: [phone]W Intemet www.naoastalmmagement^et
An E%W Cpoatwmy � Aftr= a Agon Emp CW— S% RwywC 110% Pcst Cwm;nw Paper

H PALMS AT BOCA BAY H.O.A.
REQUEST FOR ARCHITECHURAL DESIGN APPROVAL
IER(S):
ar above mentioned requests approval for the following modifications to the Unit listed above:
:hments (list separately):
reviewing the attached documentation, approval is hereby granted subject to all rules and regulations of the a
ioned homeowner association and those materials submitted and listed above:

1-IL r 40ti 40 vt' L.VK0I�-4i.. IV1.1%114nVi.1.1Vk
ADJACENT RIPARIAN PROP ERT Y OWNER NOTMCATIONf WAIVER FOR A
i me of Individual Applying For Permit: t ,!�aT P
Address of Property:
(Lot or Street 9, Street or
. . (City and Coun
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 descri tiori or drativing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to wbut is being proposed, please write the Division of Coastal
Management,.127 Caardixal Drive Extension, Wilmingtotl N C 28405 or call 910-7$6 7213
within 10 days of receipt of this notice. No response is considered the salve as no objection if
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakivater, boar house or boat lift must be set
bek a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
Nvish Tve r ack,-you mast initial the appropriate blank below.)
I. do wish to ;naive the I' ' setback requirement.
I do not wish to waive the 13' setback r' equiremer)t.
1YY'L • �- Sv(I 10 -1
Si me Date
Print Name � • .
�r
NCDENR
Telephone Number with Area Code

Name of Individual Applying For Permit: �—
Address of Property: "I ( f >Q
(Lot or Streef 4, Street or Road)
(City and
7
I hereby certify that I own property adjacent to the above -referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development they
are proposing. Ad 'on or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objeetiotis to what is being proposed, please write the bivision of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 919-796-7215
within 10 duys of receipt ofthis notice. 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, boat house or boat lift must be set
bek a minimum distance of 15' from my area of riparian access - unless waived by me. (If you
wish waive the setback-, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requ€rement. '
); do not wish to waive the 15' setback 'requirement.
i
sue lo-tv-4
Sign NVne Date
Print Name T
3 Z
"I oak 0
Telephone Number with Area Code NCDtf4R

)licant: ,DOV A/W 6 ✓ 4-/l
e: 10 1-31t d
Permit #:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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)
Dredge ❑ Fill ❑ Both ❑ Other
ye
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 ❑

VALENTINE CONSTRUCTION 1438
PH. 910-471-5849
480 ANDREWS RD
HAMPSTEAD, NC 28443 87-719412532
PAYTOTHE °ATE
ORDER OF
$
DOLLARS
First Federal
FOR
1: 2 5 3 27 L 9 4 51: 580 600 2 70 lip' 0 It. 38