57471D - McLamb

Division of Coastal Mgt. Habitat impact Computer Sheet
licant: Aotri A -` Permit #: 5 �
o1/ 1 1
-ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
tat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
)�
Dredge ❑ Fill ❑ Both ❑ Other
`
I
Dredge ❑ Fill ❑ Both ❑ Other��
S
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 ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date `S
Name of Property Owner Applying for Permit:
l f l,'f K /' Irte-4
Mailing Address:
I certify that I have authorized (agent) /' /��I ' to )�ton my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) 3

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property:_ h" '41 �%►n &Aek 61,P4100,L)Ae
(Lot or 9trect #, Street or Road, City & County)
Applicant's phone #: / ��/� .-a 'D5K) Mailing Address: i a S vf,,/ — j' `
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me as shown on the attached drawing the development they are proposing. A descriQtion
of drawing. with dimensions. must be provided xvith this letter.
I have no objections to this proposal. 1 have objections to this proposal.
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. Correspondence should be mailed to 127 Cardinal Drive
Ext.
Wilminuton, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no ob&t- ion 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.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information) (R
Signature

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: w k z4rZ4mb
Address of Property:
(Lot or Streit #, Street or Road, City & County)
Applicant's phone #: L Mailing Address:
ode e
a 3y�s
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me as shown on the attached drawing the development they are proposing. A description
of drawing. with dimensions, must be provided with this letter,
�V I have no objections to this proposal. 1 have objections. to this proposal.
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. 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 objection 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.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signature
(Riparian Property Owner I formation)
Sign e

J
J
fvq�

ALLIED MARINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443
PAY TO THE /
ORDER OF (/
rG
MEMO � ` � tCJ✓� ��. /s,. _ _�
"80047S 2"' 1:0S3000 L96i: 000684
Bank of America
ACH RR 053000196
E
THO D SIGNATL
74373

■ 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: /
&ArtiAe, �ti-
A: Sign
X � C� -
❑
Addressee
B� Receiv by (P ' d Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES. enter delivew_address below: 2—<
Cze " 1
li Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service label) 7 011 0110 0 0 0 0 0 5 51 1663
PS Form 3811, February 2004 Domestic Return Receipt
■ 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:
C�l1G�(d /V�i
A. Sic(nailfe/ /%3V v r� U,
102595-02-M-1540
❑ Agent
JCL-- ❑Addressee
B. Receiv� by (Printed Name) .C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
oj
S 28021
3. Service Type
'',<Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
2. Article Number
(Transfer from service label) 7 011 0110 0000 0551 1656
❑ Yes
S Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540