57392D - Muse

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Beverly Eaves Perdue
Governor
Date: & / - ) )
A,
NCDNt
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
James H. Gregson
Director
AGENT AUTHORIZATION FORM
Name of Property Owner Applying for Permit:
l ro d d Wet -
Mailing Address:
C'jeg&, bo fa,, 1IG d74o 9
Phone Number: (33h - oZ l `- 16 7(0
Dee Freer
Secre
I certify that I have authorized (agent) C WA r le 5 /YLa r'2 e, to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
construct (activity) 66af C. r-P' ,
at (my property located at) S12b ro �t 0-e-&n 15 /& &AGh , NC—.
This certification is valid thru (date) � - /— / 1

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: ,u7S'Rj'� `) SZ
(Lot or Street #, Street or Road, City & County)
Applicant phone (�A �- Mailing Address:
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 or drawing with dimensions must be provided with this letter.
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
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact—dcm.htm or by calling 1-888-4RCOAST. 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 wis h to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
/')'1 e r'e) . `1-6 6. %YI u S -e-1
Print or Type Name
. y. �' Armou.nr Frms
(Riparian roperty Owner Information)
Signature
Print or Type Name
r-
r
Mailing Address
Mailing Address

Address of Property
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
(Lot or Street #, Street or Road, City & County) 5yV
Applicant phone Mailing Address:`
I hereby certify that 1 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 or drawinq with dimensions must be provided with this letter.
'' 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
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. 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 wis h to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
�l e
Signature
Print or Type Name
(Riparian Property Owner Information)
I ture
�t
Print or Type Name
Mailing Address Mailing Address

11
Proposed Boatlif t iu
[t
Top of Concrete

C Mvision of Coastal N19t. Habitat Impact Computer Sheet
)plicant )D OmA i1l�.�r� , v c Permit
ite:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat Name
)w
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)
Dredge ❑ Fill ❑ Both ❑ Otherx
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 0 Other ❑

Mareene Construction
p. O. Box 370
Supply, NC 28462
PAY
TO THE
ORWER OF
(CQ
BRANCH BANKING AND TRUST COMPANY _1
7-800-BANK BBT BBT.Com
FOR
e0000 L 2 3 3111 :0 5 3 L0 L L 2 Li:000 5 LO 4 2
r°
DATE ( I