57313D - Davis

X4
)1-11 --- h

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIA100RIVG PI.LI_VGSZBOATLIFTiBOATHOUSE)
I hereby certify that I own property adjacent to AtJ3 % S
. - (Namgof Property Owner)
operty located at
F (Lot, Block, Road etc.)
in 1A sTt3 1� Tc'S�� N.0
(W rbody) (Town and/or County)
has described to me, as shown below, the development he is proposing at that location, and, I have
Objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
ck a minimum distance of fifteen feet (15') from my area of riparian access unless waived by me.
(If you wish to waive the setback, you must initial the appropriate blank below.)
` I do not wish to waive
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by yin—dividual proposing development)
you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in wi
thin 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, r
:M representatives can also be contacted at [phone].
No response is considered the same as no objection if you have been notified by Certified Mail
nformation for Property Owner/Applicant
Applying for permit)
failing Address
i /State/Zip ,/
% 0 / % �
(Riparian Property Owner Information)
S ipatuw
Print or Type Nan

(FOR A P1ER/iVI UUR -.V &-PIL1_*V UJilf UA 1 L1141%!f Uri 111 U o'JC)
hereby certify that I own property adjacent to
.y located at .1167 / K% u
(dame of Property Owner)
(Lot, Block, Roah, etc.)
(Vat rbody) (Town and/or County)
described to me, as shown below, the development he is proposing at that location, and, I hav i
actions to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be s
minimum distance of fifteen feet (15') from my area of riparian access unless waived by me.
(If you wish to waive the setback, you must initial the appropriate blank below.)
_ I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
? cI� i
lave objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in i
10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington;
epresentatives can also be contacted at [phone].
No response is considered the same as -no objection if von have been notified by Certified Mail
mation for Property Owner/Applicant
Applying for permit)
.g Address
Z rUe a.p YoY
tate/Zip
(Riparian Property Owner Information)
C/.,
Sio t
Print or Type N

11 09:38a Kim Parker 910-270-0500
P.1
ADJACENT RIPARIAN PROPERTY OWNER STATLNMNT
(FOR A PIE"IOO.RLYG PIL.LYGSIBOATLI4CTI.BOATHOL'SE)
I hereby certify that I own property adjacent to
property 1141 j �/,h� j ` ' ht I Q fame of Property Owner)
ro locaud at t!-T 1U t .lLvLd�t j�(
or. U (L , Qk,- -ead, te.)
N.C.
(Waterbody) (Tow and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objection9 to his proposal. I understand that a pier/mooring pilings i bow1ift / boathouse must be set
back a minimum distance of fifteen feet (151 from my atca ofripariaa access unless waived by me.
(If you wish to waive the setback, you must initial the appropriate blank below.)
I do not wish to waive
gl' I do wish to waive that setback requircrat nL
DESCRDMON AND/OR DRAWING OF PROPOSED DEYEiOPWNT:
(To be filled in by individual proposing development)
if you baveabjecpons to what is being proposed, you taust notify the Division of Coastal Managentont (D('.M) in writing
within 10 days of receipt of thu notice. Correspondence should be mailed to 127 Cardinal Drive EXL Wilmington, NC
DCM representatives caw 4110 be eontl.e-ted at [phone].
No_MDon" h co tildcred the -tame no o6kYtion if you hove been noVZ! by Grtifted Mail
(Information for Property Owour'Applicsat (Riparian Property Owner Information)
Applying for permit)

fi�
�j'A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freer
Governor Director Secre
AGENT AUTHORIZATION FORM
Date: ° r Y _ /J
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
rf\:C ArL �h�'. G mor: o i b&21- Jb0Cx f lam"
Owner's Mailing Address:
) q 12 ►lt a(D t3,1
L-0 a P ee g, V Y 6 �(
Phone Number (91) yoZO 9JIV6
A ent's Mailing Address:
TL
Phone Number (fin 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):
(my property located) at ./A % 0" s t Av J ""I '�O- L�s
This certification is valid thru (date)
/
Property Owner Signature
Date

C Division of Coastal N19t, Habitat Impact Computer Sheet
plicant: Permit #:
qp S3
te:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
)itat Name
/ W
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
' (Pct
I ��
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 ❑

DELTA DOCK & BOAT LIFT
PO BOX 3532
TOSAiL BEACH, NC 28445
PAY
THE
OR j%l
ORDER OF --IV
V
®First Citiz ns 5 41, :3t�
Bdllli� ��
c
8293
DATE 66-30/531
365
flrstcit' ena.com 31 ZD
FOR
ii 008 2 9 to 1:O S 3 100 3001:00 3 S 3 19 91SO4111.
f
OLLARS