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Item Number: 7010 1050 0000 8472 2473
This item was delivered on 03/25/2011 at 13:31
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UNITEDSTATES
POSTAL SERVICE
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Track/Confirm - Intranet Item Inquiry - Domestic
Tracking Label: 7010 1060 0000 8472 2473
Destination ZIP Code: 27614
Origin ZIP Code: 28443-2174
Class/Service: First -Class Certified Mail
Service Calculation Information
Service Performance Date
Scheduled Delivery Date: 03/25/2011
Weight: 0 lb(s) 2 oz(s)
City: RALEIGH State: NC
City: HAMPSTEAD State: NC
Postage: $0.61
Zone: 01
Delivery Option Indicator: Normal Delivery PO Box?: N
Rate Indicator: Single Piece - Letters
Special Services Associated Labels Amount
Certified Mail 7010 1060 0000 8472 2473 $2.80
Return Receipt 7010 1060 0000 8472 2473 $2.30
Event
Date/Time
Location Scanner ID
DELIVERED
03/25/2011 13:31
RALEIGH, NC 27614 030SHAM723
Input Method: Scanned
Finance Number: 366370
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ARRIVAL AT UNIT
03/25/2011 09:29
RALEIGH, NC 27609 030SHCB141
Input Method: Scanned
ACCEPT OR PICKUP
03/24/2011 13:44
HAMPSTEAD, NC 28443
Input Method: Scanned
Finance Number: 363352
Enter Recluest T pe and :tern Number:
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Letter of agent
I �zlifo fi Kenneth W Futch_✓have retained Mark
Clements DBA, Clements Marine Construction Inc, to make application for any and all
permits needed to start construction on the work requested for our property or properties.
By allowing Mr. Clements to make such applications I do understand that this will in no
way relieve me of any obligations to perform all work according to the building codes of
North Carolina, CAMA, DWQ or any other state and or county ordinances.
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Print name
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gnature
910-675-9929 date 03/16/2011
Contact information

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1�)(JA410 P%Jkb 's
(Name of Property Owner)
property located at oxeeK u W w j E
(Lot, Block, Road, etc.)
on 1'Yl J1 caulin 141,hAobAe,-J , N.C.
(Waterbody) 1 (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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IC Division of Coastal N19t, Habitat Impact Computer Sleet
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escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
,und in your Habitat code sheet.
9bitat 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
impactamount)temp
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
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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 ❑

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