55820D - Jackson

t1CAMA / ❑DREDGE &FILL
GENERAL PERMIT Previous permit #
�1 ew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
:)ri;ed b;+thz State of North Carolina, Department of Environment and Natural Resources /7 u
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
[giules attached.
nt Name lye Is GT,-,, G'C/�Jj G jProject Location: County 174 a ek
; 6 go 7 'x?/ 'k, "., k d . Street Address/ State Road/ Lot #(s)
174 e <v, Pe State /►/C ZIP 2 73b-?
§6 Lly&/WFax # ( ) Subdivision
zed Agent Chi/l Pl /rlArtCity HOAlij ZIP
i ❑ Cw 5�m 5-PTA L�;i6- ❑ PTS Phone # ( ) River Basin a ��
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body ('A,,O L Olfr 4 wA✓ (nat�
❑ PWS: ❑FC:
yes / irio PNA yes —, Crit.Hab. yes / no Closest Maj. Wtr. Body !"/� y
/r
if Project/ Activity 1�4 ,0 f� Pit °' (2) L L F%''f /'t 2--'A
ad/ Riprap length
✓g distance offshore
iax distance offshore
:hannel
Joic yarns
ne Length
i
not sure yes 1�1
gs: not sure yes (5,� f
mum: n/a yes
es no ' 2 .S bf A
Attached: yes no �/ //
ling permit maybe required by: // OL (/Gi✓
❑ See note on back regarding River Basin i
I . - J D 1 1 /

Canal
Proposed Elevator Lift
t-; Proposed
Elevator Lift
#2 �
1
1 236 sq ft
of total
deck space,
6' - 6'
i
0
15' setbac
9

AVZWA
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Dlrecbr
AGENT AIJTHORIZATION FORM
Date:
Name of Property Owner Applyying for Permit:
N eAl Oh/ Ja� c �.y
Mailing Address:
.2 k
Phone urnber 010_1
Dee Freeman
Secretary
certify that I have authorized (agent) L!4 es to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to instal or
construct (activity) &Ij r)O,;1L a
at (my property located at) /1 .?,
This certification is valid thru (date)
4zv
�z�
Property Ow Ignature Date

LISPS - Track & Confirm
Yage 1 of
�(INITEDSTATES
Home I Helt
PQSTAL SERVICE:
sign
Track & Confirm FAQs
Track & Confirm
Search Results
Label/Receipt Number: 7007 3020 0001 5068 1958
Service(s): Certified Mail'" Track &Confirm
Status: Delivered Enter LabeUReceipt Number.
Your item was delivered at 2:16 pm on February 14, 2011 in
ASHEBORO, NC 27203.
Detailed Results:
• Delivered, February 14, 2011, 2:16 pm, ASHEBORO, NC 27203
• Notice Left, February 12, 2011, 3:14 pm, ASHEBORO, NC 27205
• Arrival at Unit, February 12, 2011, 8:03 am, ASHEBORO, NC 27203
Notification Options
Track & Confirm by email
Get current event information or updates for your item sent to you or others by email. (60>,
Site Map Customer Service Forms Gov't Services Careers
Copyright© 2010 LISPS. All Rights Reserved. No FEAR Act EEO Data FOIA
tems 1, 2, and 3. Also complete
;stricted Delivery is desired.
lame and address on the reverse
can return the card to you.
card to the back of the mailpiece,
�ont if space permits.
,ssed to:
:--(%/z&a,-,,�'T
Privacy Policy Terms of Use Business Customer Gateway
® f'. "I - -
A. Signature
X
B. Received by ( Printed Na e) C.
D. Is delivery address item 1? lJ YeE
If YES, enter add dress below: No
(p�t
/

LISPS - Track & Confirm
Page 1 of
UNITEDST13TES
Home I Help
POSTAL SERVKE=
sign
Track & Confirm FAQs
Track & Confirm
Search Result,
Label/Receipt Number: 7007 3020 0001 5068 1941 -----
Service(s): Certified Ma IT" Track & Confirm
Status: Notice Left Enter LabelfReceipt Number.
We attempted to deliver your item at 1:20 pm on February 14, 2011 in
CHERAW, SC 29520 and a notice was left. You may arrange redelivery
by visiting www usps.com/redelivery or calling 800-ASK-USPS, or may
pick up the item at the Post Office indicated on the notice. If this item is
unclaimed after 15 days then it will be returned to the sender. Information,
if available, is updated periodically throughout the day. Please check
again later.
Detailed Results:
• Notice Left, February 14, 2011, 1:20 pm, CHERAW, SC 29520
• Arrival at Unit, February 14, 2011, 8:45 am, CHERAW, SC 29520
Notification Options
Track & Confirm by email
Get current event information or updates for your item sent to you or others by email. Q�>
Site Map Customer Service Forms Gov't Services Careers
Copyright© 2010 USPS. All Rights Reserved. No FEAR Act EEO Data FOI
Privacy Policy Terms of Use Business Customer Gateway
A

cant: /,/ e ISo -,g 1�l6�
Permit
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
nd in your Habitat code sheet.
litat 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 fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
/
O (/"
Dredge ❑ Fill ❑ Both ❑ Other
—3/ 2-
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 ❑

Mareene Construction
P. O. Box 370
Supply, NC 28462
PAY
TO THE
ORDER OF
i
m
BRANCH BANKING AND TRUST COMPANY
1-8800-BANK BBT BBT.Com / a
FOR �.�11''�} 55so'M dP�Cj - J 3"yo (b
/i
ii'0000 1 154ii' ':0 5 3 1011 2 0:000 5 104 2 13 3 Lao
0