57502D - Davenport

3'CAIVIA / F7 DREDGE & FILL
."3ENERAL PERMIT Previous permit #
lNew ,Modification L_]Complete Reissue 0 Partial Reissue Date previous permit issued
riled by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
E;i.ftles attached.
it Name ► Q"V1 0, 1 7 Project Location: County
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yes / no PNA yes / no Crit.Hab. yes / no
Phone# (—) - River Basin
Adj. Wtr. Body EA 1Q:7W 0 ( t*IJ
Closest Maj. Wtr. Body A' yJ �
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F19 permit may be required by:
El See note on back regarding River Basin

American Fish Company
f"w P.0 Box 11046
x r Southport. North Ca►oMa 28"
Email AK03600®aoi r_om
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INVOICE NO
r, P. p) eoaS [. to
a �14 NOc� Fes * berdin�
So
(910) 457-548
(910) 457-655
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I o : -34S?6551
Name of Individual Applying For Perri tt . •.0Mm�l
Address of Proper ,pap
,Lot or Street is, Street or Road) -
(City and County)
1 hereby certify that I own property adjacent to the above -referenced propeny-- The in
applying for this permit has described to me as shown on the attached drawing the deveioprr
are proposing. A description or drawing, with dimensions, should be provided with this
✓ I have no objections to this proposal
It' you have objections to what is being proposed, please write the Divisitn of
Management, 127 Cardinal Drlvo Extension, Wilmington, NC 28405 or call 91:1.71
within 10 days of receipt of this notice, No response is considered rile same as no obji
you have been noticed by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, brenlnvater, bout house or boat lift mu
bck a minimum distance or 15, from my ores of riparian access. unless ai.-ed bv rne.
wish to waive the setback, you must initial tho appropriate blank below,;
':42 1 do wish to waive the I ac set me, b k reou�re,,.,,. .
i do no wish to waive the 1:' setback rcquirc re:n,
VV — "
Nfl�:lld
F.
?rin, Name

! � : 'T+5 ; 655'1
Name of Individual Applying For Permit: _ mI 'D(3,,VC rT
Address of Properc},0&0 vic'-' t-
(L.ot or Street 4, Street or Road)
DOLJ< ZS' aruVAsW t Q
(City and County)
I hereby certify tl7at I own property adjacent to the above- referercto propcn-y. The in
applying for this permit has described tome as shown on the att-ached drawing the devtiopn
are prorosine. A description or drawing, with dimensions, should cc prcvi.d with this
have no objections to this proposal
It' you have objections to what is being proposed, please write the Dig 5iGrl of
Management, 127 Cardinal Drivo Extension, Wilmington, NC '8405 or c:ill 91'i-7
witbin 10 days of reeoip,t of this notice. No response is considered the some as no olsJ,
�'Qu have been noticed by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, brenlcwater, bops mouse or boat lift mU
bck a minimum dlstanee of 13' from my area of riparian access - unless wain ed b% me.
wish to Waive the setbock, you must initial the appropriate btar,k below,;
.._ do wish to wsive the 1 setback require".e�:
I do not Nish to waive the i
V`1 4-s
?rint Name �.>�

ar`c,i K
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Micnael F Fasiey, Gevemor James H. Gregson, Director William G R(
Authorized Agent Consent Agreement
is hereby authorized to ;ir. cri
(Pnn)b0 Name oI AgenO
in order to obtain any CAMA p rnit(s) required for the property listed below, The authorization is !;I
specific activities described in the attached sketch.
LOCATION OF PROJECT:
PROPERTY OWNER MAILING ADDRESS:
PHONE NO l0-zig - 4705
AUTHORIZED AGENT MAILING ADDRESS:
Y
PHONE NO, "l l0- W L13L.,,,5
Signature of Property
Q>-vner
Signature of Authorized Age _
n=ra d A o L

l
American Fisn company
P.0 Box 1 1046
' Southport. North Carolina 2846,
-VIOL Email AFC036006aol Corr
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400 r �
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poG�' $ocr0�n�
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INVOICE NO M
[phone]
[phone]
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applicant: . D W
late: ,
Permit #: v) I �G'&
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurem
)und in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft.
(Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance.
abitat Name Choose One includes any Excludes any
anticipated restoration
restoration or and/or temp
temp impacts) impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feel
(Anticipated I
disturbance.
Excludes any
restoration ar
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other 4�f
-70
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Dredge ❑ Fill ❑ Both ❑ Other
If
i.N l7
Y I
Dredge ❑ Fill ❑ Both ❑ Other ;a/
J 0
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 ❑

THE AMERICAN FISH CO.
CHARLES H. OR KAREN Z. PERRY
P.O. BOX 11046
SOUTHPORT, NC 28461
DATE q `2-I"0
PAY d
TO THE I �D
ORDER OF 70, 1
First Citizens
Bank (� G� riL
FOR In.1}ltat 'rt e C"'��q5 ( -)
11108 3 50 9ii' ':0 5 3 L00 300l:00 4 5 3
1 2099 2