57364D - Kimel

CAMA / 1 DREDGE & FILL
iENERAL PERMIT Previous permit#
New ❑ Modification [-]Complete Reissue ❑ Partial Reissue Date previous permit issued,
ized by the State of North Carolina, Department of Environment and Natural Resources /
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
[9ftles attached.
Name L ,E''< Project Location: County
Street Address/ State Road/ Lot #(s) ///
— r ; --- — - State --- ZIP
iD41)Fax # O
Agent /,.a,I ,- d .0
❑ CW
❑ OEA
❑ PWS:
(es 4 no
❑ EW DPTA C=.ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
PNA yes /Crit.Hab. yes / no
Subdivision
City %� I aor SOfAc ZIP 2 g y6
Phone # ( ) River Basin ,/
Adj. Wtr. Body �ANA L d� 4141/11"(na>ttrn
Closest Maj. Wtr. Body /!�/
Project/ Activity eP�2c-.e -r-,
LA1—k /- "e . r (Scale: <<
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iber
Riprap length
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distance offshore
(distance offshore-
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Length
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g permit may be required by: N(/ &A011 9"e- ❑ See note on back regarding River Basin ru

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee Frei
Beverly Eaves Perdue James H. Gregson
Governor
Director Sea
AGENT AUTHORIZATION FORM
Date:
Name of Authorized Agen for this project:
Name of Property Owner Applying for Permit: r r 1C� ( ` J�
(� r � Il YYl ��
Owner's Mt7lina drejS:C,�
Phone Number (-�3(6)
Agent's Mailing Address:
�c�,� �51e f v � Ir► I�� _
Phone Number f LU)
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or constr ct the followin gctivity):
(my property located) at i 1 k '30-
This certification is valid thru (date)
-R S A et,
�7h 1 ,
5-22--1
Date

1)' cd /)%tz �—
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Jame of Property Owner:
kddress of Property:
Ckr
(Lot or Street #, Street or Road, City & County)
kpplicant's phone #:�— '�(OG 33uc�1 Mailing Address: Lb6 L-QA� r4 U r-
-Q—
hereby certify that I own property adjacent to the above referenced property. The individual applying for this per
ias described to me as shown on the attached drawing the development they are proposing. A description of drawi
with dimensions, must be provided with this letter.
l/ I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management (DCP
In writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive I
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
[ understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial'the
appropriate blank below.)
,,� I do wish to waive the 15' set back requirement.
1%� I do not wish to waive the 15' set back requirement.
(Property Owner Information) (Ripiitrian Property 0 r Information)
Signature
U- rv� t;I
Print or Type Name
453 LQa%f-CA
IYlailing Address
Signatur
Print or Type Name
Mailing Address

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: CAV-rv1'-8�----
Address of Property: �111 _ rr v_�_._ \� ��'\Q`1 r �A
{Lot or Stree 4, Street or Road, City & County
Applicant's phone Mailing Address:
I hereby certify that I own property adjacent to the above referenced properly. The individual applying for this permit
has described to me as shown on the attached drawing the development they are proposing. A description of rawing.
with dimensions. must be provided with this letter,
4' 1 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCK
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no oblection_if you have been notified by Certified Mail. —
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
appropriate blank below.)
iz—� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signature
Print or Type Name
Lc -a %-A
Mailing Address
(Riparian Property Owner Information)
Signature
_ Lh
Print or Type Name
Lonao'm-��-k R"
Mailing Address
r;hl i e to A7in

pplicant: 1. elz /) e L r
r n'1 Permit #: 23
ate: 7 fJ
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremE
and in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet FINAL Feet
(Applied for.
(Anticipated final
(Applied for. (Anticipated fi
Ibitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance disturbance.
Choose One
includes any
Excludes any
total includes Excludes any
anticipated
restoration
any anticipated restoration an
restoration or
and/or temp
restoration or temp impact
temp impacts)
impact amount)
temp impacts) amount)
Dredge ❑ Fill ❑ Both ❑ Other
n �_r-,_r,«,— rn
■ 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.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addre to:
�.h1u� � 5+�►v f f-
131\cr,ef�
1 Po,
A. Signature
Agent
/ Rec 7
ived by (Pr/n Name) C. Date of Delivery
oa
�JY
D. Is delivery address different from Rem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
0• se Ioe T ype
. Certified Mail ❑ ress Mail
❑ Registered
❑ Insured Mail ❑ C.O.D.
a. Restricted Delivery? (Extra Fee) ❑ Yes
2. ArticleNumber7009 1680 0000 2205 9458
(transfer from service /abeQ
PS Form 3811, February 2004 Domestic Return Receipt
l
102595119.M_tsen
ui -V- U rill U DUlll LJ u[ner U
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

GRICE CONSTRUCTION OF BRUNSWICK
COUNTY INC
6618 BEACH DR SW BS. 910-579-9095
OCEAN ISLE BEACH, NC 28469-4710
PAY
TO THE
ORDER OF
Q,
t
BRANCH BANKING AND TRUST COMPANY
t-M-BANK SOT SBT.com
T � 596(o
FORM I Cl,r,D' �ln S�
T
66-
DATE
DOLLARS
11 0000 rbSbu' 1:0531011211:0 � 005 1999 265 29II -�