57348D - Clayton

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Overly Eaves Perdue James H. Gregson
avernor Director
AGENT AUTHORIZATION FORM
Date:4/�7
//
ime of Property Owner Applying for Permit
,�✓z % s ems,,
Nner's Mailing Address:
3y %l.e",dPa e aed, --
",ld a// 15' 070°0
Dee Freeman
Secretary
Name
of Authorized Agent for this project:
15
Agent's Mailing Address:
hone Numberl9%3 9 " 59�36 Phone Number
dol '6;2,
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or construct the following (activity):
S 1
;my property located) at
This certification is valid thru (date) /
Property Own r Signature D to

IS MAIL.
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEM, I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
s
I hereby certify that I own property adjacent to G�,Qre le's C
(Name of Proper Owner)
property located at g
(Lot, Block, Road etc.)
on
in �e N.C.
(Waterbody)�., 9'— (Town and/or County)
Applicant's phone #: 9/D—� Mailin Addr�ss:j_'�
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
----------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
�k44 D
If you have objections to what is being proposed, you must notify the Division of Coastal blanabement (DCM) in writin
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone].
No response is considered the same as no objection if.you have been notified by Certified Mail
(Property Owner Information)
Signature �~
r, t
Print or Type Name
/9 1 k
Mailing Address
XIrian Pr perty caner nformation)
Signature
- 0 A.'s
Print or Type Name
,�?C1 401ep A",�
Mailing Address

IS MAIL
DIVISION OF COASTAL TNIAN GENMENT
ADJACENT RIPARIAN PROPERTY Oti NER STATEMENT
I herebycertify that I own property adjacent to C
f � ame of ?roper Owner)
rt located at
grope y (Lot, Block, Roa(
inon
(Waterbody)�,�
Q _
Applicant's phone #:___�/��=��i —3 Mailin,
He/She has described to me as shown below the development he/she i
and I have no objections to the proposal.
--------
---------- ------------------------------- -
DESCRIPTION AND/OR DRAWING OF PR(
(Individual proposing development must fill in descril
If you have objections to what is being proposed, you must notify the U
within 10 days of receipt of this notice. Correspondence should be mai
DCM representatives can also be contacted at [phone]Pm tlnn if Vol
(Property Ovvner Information)
/t
Signature
t
Print or Type Name
Mailing Address
"9 -& . � � 7 oz/ ?A
own and/or Coun
ddress:
proposing of that location,
I
N.C.
POSED DEVELOPMENT:
ion below or attach a site drawing)
t!%7TOdE'� IgJ ev
fision of Coastal Management (DCM) in writii
Id to 127 Cardinal Drive Ext. Wilmington, NC
a
nP
or Type Name
LB
ig Address �/
nformation)

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1 — #57 STONE
2.r0.. T. - 3ACKFILL
"ACKFILL & LSJiViPA l
OVE ANCHOR
htiiOR `�' r:.:1CKF'1LliitG P
1 --- - —\
Fe J
-- - ----`, 'r I z
.• •. i j u W n.v. Vr\L v. I AL- .,-- 42- CLR.--
I W/ O.G. WASHER & tJUT
AX5 WALER ;;/ v/ "�b BOLT 3c. O.G.WASHER
PR•cOVIDE 7" DI'+. WEEP HOLES 0 V-0" O.C..
LOCATE SOTIOM 01- WCEP HOLES 0 1--0"
ABOVE MUDLINE OR 1'—O- ABOVE L &
,F CONT. LAYER FILTER FABRIC: W/ 8" CDOE LAP
-- 2xi0 SHEETING; V—JOINT OR T&G x 7'-0" LONG
�r— PILES: 8x6 RGH OR ROUND PILE W/ 25" WNJ. BUTT
i
CIttCUMEERENCE (8" DIA.) & SPACEv 8'—G" MAX
C-,C, x 10'-0" LONG
Y 'I'I'OUTIMAN
NG ENGINELFS
TOWN OF OCEAN ISLE BEACH
II' II
1"
%EI_DED TO ROD
COINCRE TE DEADM � N
POURED ON
UNDISTUPBED SOIL
fC�iSJf�(: (pAIF I
11AC A3�R
a t�ET: II
n0f rnrrc+n A On I I

plicant: C. k?-'z Z ej
te: .5/2G/I/
Permit
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
ind 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 fin
disturbance.
Excludes any
restoration and.
temp impact
amount)
SDredge
❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
�'5o
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 0 Both ❑ Other ❑

A & R CONSTRUCTION LLC
BS. 910-755-6161
621 DEER PARK DR SW
SHALLOTTE, NC 28470-5301
Pay to the
Order of
7192
66-1121531
Date
Dollars ^°
BRANCH BANKING AND TRUST COMPANY
For
��nS3LOLL2L1:00052ILIS L9��'07L92 _