57366D - Lynch

AA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date A& 114 a0 it
Name of Property Owner Applying for Permit:
any G - � yoUGEf
Mailing Address:
300 CEO%� pwx GtJEs; ,. of 81J
N� i�o 2 K /t/v,< y t pr �'f
I certify that I have authorized (agent) �44 d mafly z to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) r-ep kGe, 6oV- A Lf
at (my property located at)
A
This certification is valid thru (date)
Property Owner SkiatuW Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOAATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 6a_r L/ /— MG4— is
,r� (,N/a� me f Pro erty Owner)
property located at Zs i ` "ee-r �S ✓V �<<
(Lot, Block, Road, etc.)
on , in / ., �L)re & , N.C.
(Waterbody) 4own and/or County)
Applicant's phone #:
Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
-0eI do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
Signature
(',tv/Ctata/7,n

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTIBO/ATHOUSE)
I hereby certify that I own property adjacent to a /" L nG � 's
(Name(of Pro ertyOwner)
ZS- ?property located at
,s /i%Gx
(Lot, Block, Road, etc.)
on , in / e y��e g , N.C.
(Waterbody) V (Town and/or County)
Applicant's phone #:
Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boadift / boathouse
must be set back a minimum distance of fifteen feet (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.)
49 I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fitted in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
ii tV /CtnfP/7in
(Riparian Property Owner Information)
C16L-,,z 4
Signature
li ,4k11 �1- A -A �1
7]�:�a -- T___ Li..—_

-7 pvojx�g
�
C

CAMA D DREDGE AND FILL
GENER C
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC — ►�_!c k -✓ , (�fJ.
i
t Name Phone Number 3- �c
'roject Activity
ECT DESCRIPTION SKETCH � (SCALE:
:k) length q
igth
:r
i length a
iistance offshore . -
cannel dimensions
yards
ip dimensions
_ tir
I
E
�
—
m
mit is subject to compliance with this application, site
and attached general and specific conditions. Any
rho nnrmittot+ to a fine ._

tinCl %%n� 11
ins lt4tk— f & s Marine Contractors, Inc,
P.O. Box 868
/V G �k Ughtsvii►e Beach, NC 28480
[phone]
CA
N
OL tlS�o
8wb �unfLi�� CO2(Ld
/;z /
�r .22V Pr RECEIVED
JUN 0 2 2011
i_ ./_�/ qr AI

Division of Coastal Mgt. Habitat Impact Computer Sheet
ilicant: L9y1e, I, Permit #:
cribe 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
a�V
Dredge ❑ Fill ❑ Both ❑ Other
I �,
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 0 Fill ❑ Both ❑ Other ❑

Bank of America
ACH R/T 053000196
ALLIED MARINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443
PAY TO THE A J
ORDER OF
MEMO , —G( oq, (o(UChI )
AUTHORIZED SIGNATL

■ 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 Addressed to:
��e.l'T /l7c�f vfe
330 7
4 /a , .VC- Z 7617
2. Article Number
(Transfer from service label)
A. Sig rre -�Z
X �� b Agent
❑ Addressee
B„ Re eived by (Firintetl % me) C. Date of Delivery
D. Is delivery address different from item 17 ❑ Yes
If YES, enter delivery address below: �E]No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery?(Extra Fee) ❑ Yes
7011 0470 0003 5101 1113
PS Form 3811, February 2004 Domestic Return Receipt
Postal
CERTIF.ED MAIL,,
RECEIPT
ri
(Domestic Mail I .
•.
Insurance CoverageProvided)
m
.1
_-I-
Postage
$
CO
'
02
Certified Fee
ED
1-_3Retum
O
Receipt Fee
(Endorsement Required)
Postmark
Here
C3
Restricted Delivery Fee
$0.00
O
(Endorsement Required)
-0
O
Total Postage & Fees
$
$5.59
05/11/2011
r-i
ent o
Sheer. Apr"No:j ------ -----------
or PO Box No. iU
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102595-02-M-1540