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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director rlii6ar^
Authorized Agent Consent Agreement
is hereby authorized !o 2c'
(Pn ted Name of Agent)
in order to obtain any CAMA permit(s) required for the property listed below. The authorizatic
specific activities described in the attached sketch.
LOCATION OF PROJECT:
0A 3�5. (� C. mobs
PROPERTY OWNER MAILING ADDRESS:
F Fes- w66(
FOR
�` ��► ,�-
PHONE NO. 3©I"4%L— lSa�
AUTHORIZED AGENT MAILING ADDRESS:
PHONE NO. 110-'PS77'S`!�$
Sicr-rature of Property Owner:
n

�Ej o kAe-r cccctC5
Name of Individual Applying For Pmvlc , J �``��[aZh W -
Address of Property'
of or Streit 0, Strut or Road)
Qa�l :l;-:5. WMWiC
(City and County)
t hmby certify that I owe property adjacent to the above- referenced property. TM individuet
applying for this pet'rnit has desaribedto me as shown on the arched drawing the dtvelcVmerrtth"
are proposing. A deicription at drawing, with dimensions, should be provided with the loiter
tf I have no 0*ctitms to thus proposa
If you have objecslons to what is being proposed, please write the Division of Co> L
Mepagement, 127 Cr;rdirrol Drive Exteasion, WIlmin; on, NC 28403 or e:,11 910.796-?li5
within 10 days of recelpt of this nonce. No ruponse is considered the same as no obleajonif
you have been notllied by Certitlad Mail,
WjkmR SECTIC
i ut►derstund that a pltr, dock, atooring pilings, broakwater, boot hou9e or boat lift a+us<t be stt
bck a min1mum diswco of IS' from ray area of riparian access • unless Nvzived b. me. (if you
wisb to waive the setback, you must initial the appropriate plonk belaw
✓ ' do wish to waive the 1 S' setback reauireme
I ' net Wish to Nvnive the 13' setback rtouirerrent
3 i qn Na aLe
Print N e fil

N Ca-�h<R
,o:1r+--�roas,
k`
Name of Individual Applying For Permit: TerrrA C2QlAo -Ch er
Address of Property:
0
of or Street 4, Street or Road)
QL�5
(City and Counry)
I hereby certify that I own property adjacent to the above- refererced propet^y. The indivi
applying for this permit has described to me as shown on the attched drawing the deveiopmem
are proposing. A description or drawing, with dimensions, should be provided withthis 1etiq
r have no objections to this proposn�:
If you have objections to what is being proposod, please write the Division; of Co
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or c:ili �' .796-
within 10 days of receipt of this notice. No response is considered the same as n object
you h2ve been notified by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, brenlovater, boat house or boat lift mist I
bck a minimum distance of 15' from my area of riparian access • unless Nvaive6 bN me 0
wish to waive the setback, you must initial the appropriate blank below,,,
do wish to waive the 15' setback reouiremer:
I do not wish to Nvaivo the 15' setback rcqu remer.,.
—i-r
Si;rn ?v'a ']ate
Print Whe

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gip''

Division of Coastal Mgt. Habitat Impact Computer Sheet
I,icaot: IC& (V fte(z/ .0
�Sh kP I
Permit #.- j(C S 1-�
gibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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 fina
disturbance.
Excludes any
restoration and/(
temp impact
amount
pry
1 V\
Dredge ❑ Fill El Both ElOther o
Cot-)
�v
_�a
�D
Dredge ❑ Fill ❑ Both ❑ Other
( o
l
[ p
V _
Dredge ❑ Fill ❑ Both ❑ Other RI/
SLi
s�$
Dred
•�3d013AN3J0.
A. Signature
�(r��1, ❑ Agent
❑ Addressee
DredENDER: COMPLETE THIS SECTION•
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
Print your name and address on the reverse[
so that we can return the card to you.
Dred ■ Attach this card to the back of the mailpiece,
or on the front if space permits.
:::�7711111111
B. Received by (Printed Name)
-'
C. D to of Delivery
a j
D. Is delivery address dill rent from item 1? ❑ iles
If YES, enter delivery address below: ❑ No
Dredc 1. Article Addressed to:
W i � 11a--M 1, � d►�
Dredc t
Dred( ��<< � c
^C`
�2ma1'i �16 S
Dred(
Dred(
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
Dredc 2. Article Number 7 010 3090 0001 4408 510 9
(Transfer from service label)
Dredc PS Form 3811, February 2004 Domestic ReturnReceipt 102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
17

THE AMERICAN FISH CO.
CHARLES H. OR KAREN Z. PERRY
P.O. BOX 11046
SOUTHPORT, NC 28461
DF Z 1 �. V• C�, \
First Citizens
Bank
firstcitizens.com
11108 2 9 50ii' i:0 5 3 100 3001:00 4 5
82950
31
DATE _s1 , - Q� — 1, 66-30 453
i $ aa© o 0
3 12099 2 2v
DOLLARS