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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date � /?0///
341- F61-
Applicant Name
Mailing Address i0 0 �/ �1, ,-� /` O� C/
1 certify that I have authorized (agent) Z—O n aAm, OPP to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)
This certification is valid thru (date)
Signature x ;

/12/2N11 1G:29
910-327-1433
COASTAL MINI STUF.AGE
FADE 011
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Gem POwAr-d
hereby certify that I own property adjacent to - — 's
(Name of Property Owner)
property located at ZL 7
(Address, Lot, Block, Road, etc.)
on �t!E U�-, P—i U ai - , in `--7-A C 645'ON Ul de / , , N.C_
(Waterbody)
Agent's Name #:
Agent's phone #:
(City/Town and/or County)
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact Information for DCM offices is
available at www.nccoasta/mangementnet/contact dcm.htm or by calling 1-8864RCOAST. No
response is considered the same as no objection N you have been notified by Certified Mail.
(Property Owner Information)
1 / e o
Signature
Print or Type Name
(Riparian Property Owner In rmation)
,
Signature
Print or Type Name
Mailing Address
145-An✓,"We AvC,
Mailing Address

MC '� III 1111111111111111
7008 1300 BUBO 2289 4408
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■ Complete puns 1. 2, W4 3. AIM COMPlete
kern 4 if Restricted Del" Is deake&
• Nnt your name and address on file reverse
so that we can return the card to you.
■ Atteoh this oard to the back of the nmllpiecs,
or on the front rf specs permits.
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x ❑ Agent
❑ Addmesee
S. Received by {?+frr7ed rlerne) ff"It"
fvery
D. re derhrery addmw dire► of from Rem 17 0Yea
If YES, enter delivery eddrees below: ❑ No
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2- AIWO Number 7008 13C10 0000 2289 4408
(Tmnsw from service h belj
Ps Form 3911, February 20D4 ocawstic Retum R"pt Iozsae -a".1s+o i

State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
Beverly Eaves Purdue, Governor
Date: a - P /'/
To: �b a,,
CO:
FAX # q i o 327 - (Y33
REMARKS:
Dee Freeman, Secretary
FAX COVER SHEET
NO. Of Pages: (excluding cover)
From: %r5el-�, Lz c,
CO: Division of Coastal Management
FAX#: [phone]
G1.Pz &4 6,-,tf 60t-r o k
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3945 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer

flicant: Permit #: �EO/2Ewi9'1cD 5-743Z
e:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
rid in your Habitat code sheet.
DISTURB TYPE
itat Name 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
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Dredge ❑ Fill ❑ Both ❑ Other
Z-/p
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 ❑

PAY TO THE (�
ORDER OF � -
COASTAL DREDGING, LLC
2075 HWY 172
P.O. BOX 295
SNERDS FERRY, NC 28460
[phone]
i
FIRST FEDERAL
HAMPSTEAD, NORTH CAROLINA 28443
67-7194-2532
rmarom �.aw,®
MEMO
6 a AUTHORIZED SJGNA RE
114003S0111' 1:2S327L94Si:
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