57322D - Davenport

' CAMA / - DREDGE & FILL
� ENE,RAL PERMIT Previous permit#
i,Nbw JModification El Complete Reissue ❑Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
TA Rules attached.
it Name Itr v1 tJIA�� 1i ;tL1' j' Project Location: County
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:ed Agent pityZIP
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ng permit may be required by: o ElSee note on back regarding River Basin r
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12/2011 11:52 205-814-4798 PELL CITY LIB PAGE 0
0
Page I of
Fax Cover Sheet
TO
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S�JZDG(L
Fax Number
3y 5
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From 6RGIMIR 3. Fad
Fax Number (205) 814 — 4798
[Telephone Number (205) 884 - 1015
Message
LIQE- of OeGlTrz,�a t3 P\ND RNA Si�1 � �5
ANC

RZIENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
►everly Eaves Perdue James H. Gregson
I
overnor Director
Dee Freemar
Secretar}
AGENT AUTHORIZATION FORM
Date: nazi)
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
RQ6F9- � bhVEN n�>2� ��-l'2i�k HNiNrn.i
wner's Mailing Address:
Agent's Mailing Address:
Z'74 WAUIS (-&t-k lei .
I ac.kswy i l 1p. KC ZS5 No
hone Number(15�1 q39 - 2$75 _ Phone dumber( IlD ) I3b'�SDb
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):
IiF._. \ L. tt,L �- v%l ic.n i TI- 1;n1BIkIn h(Ai Ian o6 E'ciS- tAl LD)f
�
►s+;� d��k
qnv
s�,�
;my property located) at
LoZZ
SLLq--C CI"1 V Nf.C-
This certification is valid thru (date)
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to ZC>6F-2fi bpVCN 12C 2J- 's
(Name of Property Owner)
property located at 6 OZZZ 5 LQLC C-i+�J NC-.
Address, Lot, Block, Road, etc.)
on UA M% in QW51012) Cmkh N.C.
(Waterbody) (Town and/or County)
He has described to me as shown in the attached application and project drawing(s), the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
6CDVE 400 + AL DCLI(
�-:w 15D vti. (f bulkA&4d
J . - 0 1 _1- AP
Signature
Print or7ype Name
Telephone Number ;
v�
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ate /
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'26/2011 09:45 9196582410 KORNEGAY REALTY PAGE
8P'.20. 1011 9:2dAM GUY C LEE SNEADS FERRY No.2994 1. 1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to -
(Name of Property owner)
Property looated at � f-�
,
Addross, Lot, 61ack, Road, eta.)
on in DN c-'Q ,1 DV 6 _, N.C.
(Waterbody) (Town and)or County)
He has described to me as shown In the attached appllcatlon and project drawing(a), the development he is
proposing at that location, and, I have no objections to hie proposal,
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ID Division of Coastal Nigt, Habitat Impact Computer Sheet
)plicant: Rouyl� �C�' l bl� Permit #: � :5,-z
ate:H/�V L 1
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
bitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
Dredge ❑ Fill oth ❑ Other ❑
I !V O
Dredge ❑ Fill Both ❑ Other ❑
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Dredge ❑ Fill XBoth ❑ Other i
�6D
q6b
Dredge ❑ Fill ❑ Both ❑ Other
Dredge Fill ❑ Both ❑ Other
3u ©
IDj
k)
Dredge ❑ Fill ❑ Both ❑ Othery.,
1
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 0 Fill ❑ Both ❑ Other ❑

BEAVER CREEK FARMS
)00 WYSEE FORK
ROA 8526 448-1505
DOVER, NC
)F -
JCN PNG AND TRU
gg COMPPA/NY
2401
66-112/531
BRANCH oleo,
DATE Y - _L
1046
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