57395D - Mulligan

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
ft
Date
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Name of Property Owner Applying for Permit:
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Mailing Address:
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I certify that I have authorized (agent)�r{ Prti'� l rn . lbrink Cevi r, to act on my
behalf, for the purpose of applying for and obtaining all CA?NIA Permits necessary to
install or construct (activity) . Fu /L- heryW/1�� Qf LL�19�t l
at (my property located at) //8 5-eaau i Cf. ( /W 36 # 3
This certification is valid thru (date) 0%c�
Yronerty Vwner �)iEnature
Date

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FAX NO.
Jun. 21 2011 11:16AM P2
?lea 'W_ Sr. p 63 VYA Ffk'X 4 r ( Erns
=1FjBD NAM RE?URY kXC:ECPT REQUEF IUD
DIVISION OF COASTAL I)IA:NA.GEMENT
ANTACENT RIPARIAN PROPMTY OWNIM STATFIi UNT
1 hereby certif'V fiat l owes property adjaeel t to a nle
�(Name of k'x•a Owner)
,3
u (Lo' Baoek, Road, etc.)
in
N.C.
(Watetbody) OwJ) mild/or County)
Appii=t's phone Maid Address:
IWShe has described tome as shown below tho deveiopmot c(she is ng at that location.
and I have ino objections w ft propos.�.
DESCREMON AND/CAR DRAWING OF PROPOSED DEVE LOPAIMq ':
a ndwizbzdproposing der4.lopmeni must fill w dercroWn bt6aw or attack a site droving)
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11 yDu nave Objections to what Is being propasoil, you met ootiv the Davis o of C i ?#L-nw rnimt CbCfY1} in
wfthis 10 days of receipt of this notices Correwond$nee sbotld be mailed ea 121 C rdiod Drive Exi M11miaWn, NG
DCK rtpresentathes ma Alga be coutaeted at (910)196r7215,
0 response is AGnsidered the MR -SUE nQ pbisction if You h3 a b_e_eLWqQMd R1
(Property Owaesr Informatton)
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Print or Type Name - �^
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(Riparian Property Owner Information)
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NOR -MAN SAYER
Print or Type Nme
7. 117 $,'GIt7 Doe.
Maslina Addr
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City I State / Zfp

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104

IC Division of Coastal N19t, Habitat impact Computer Sheet
),plicant:� 21.L U `� Permit #
ate:
�a
Cf 5-13� r-
ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Lind in your Habitat code sheet.
bitat 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)
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 ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑

LIGHTHOUSE MARINE
CONSTRUCTION INC
PO BOX 2532
SURF CITY NC 28445-0028
PAY
TO O" THE
OR� r
DER OF (--�/
BankofAmerica �%j
ACH RAT 053000188
FOR �� 5�05 ,/l�"�oo
96i;
DATE j �Z2
l Cj`J�
DOLLARS
2 3 700 5 4 l 588 7118
41
66.