57363D - Rose

CAMA / DREDGE & FILL
36E N E RAL PERMIT Previous permit #
Af w .. jModification El Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources //DO
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
If�Roles attached.
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❑ CW E7 EW F] PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
❑ PWS: ❑ FQ
yes / no PNA yes / no Crit.Hab. yes / no
Project Location: County 3/7
Street Address/ State Road/ Lot #(s) /,?t/ rri2PQAll
Subdivision
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ng permit may be required by: /% GO/pN sotic, ❑ See note on back regarding River Basin n

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561
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CCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
AGENT AUTHORIZATION FORM
Date: ^ / 1
Name of Property Owner Applying for Permit.
Owner's Mailing Address:
Phone Number (y 1C) �.Z Z
Dee Freeman
Secretary
Name of Authorized Agent for this project:
Agent's Mailing Address:
r
Phone Number(
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 construct the following (activity):
12�'i)It4C� 1,,11 K�f�a� 11C iti> f Al -,/ i-&,-Lk
(my property located) at Z (� %1� Fti S� : Y" �f
This ce ification is valid thru (date)
,-�-� ��

/f&-.; - (}L{,VC.-
ADJACPNT RIPARIAN PROPERTY OWNER STATEMEN"P
I hereby certify that I own property adjaccot to tA(N _'v
(Marne of Property Owner)
property kwAtul At i 3N
(Lot, Block, Road, tic.)
on _� 1UI{ n�_ _. in �C1G Kl (�_'� t/; fk° N.C.
••tfllr�Ofly� (Town and/or CAwnty) —
Appikaat's phone N. Mailiagt kddrm: alboi t�l trC'
I le has de-cribed to at, as shown holow, the development he is proposing at that location, and, I
have no ohjectiorts to his propusnl.
--- — -- -- ��_ —-----------._.. —
DUCRWrION AND/OR DRAWING OF PROPOSBD Deni,ormENT:
(To bejUkd in by properly owner proposing dewlnpmenr)
Fftti5tF1]i Gf?[�L��.� �[C� F15I5
..—........................ .......------
(Information for Property Owner Applying
for Permit)
tY' _�,b�_�.; Are
Mailing Adtlroas - —
C' tatc/zip
Y10 372 `���c
Number -
x,
�attt>e , .
(Riparian Property Owner fafoorrmaat
"sigttttum
Print nr Type Name
Telephone Ntnnber
Date

pplicant: G e 2d f Permit #:
ate: �3
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremf
fund in your Habitat code sheet.
abitat 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 fi
disturbance.
Excludes any
restoration an
temp impact
amount)
L
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 ElOther ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Ric Hewett Construction
c or Cindy Hewett
Pu. 10-842-8317
1481 Stanburrty/ R.dSW
Supp(, NC ,Z8462-6037
to the
ar..of NC QC nl Z
�r
%i'auo
BRANCH BANKING AND TRUST COMPANY
1- -BAN B T J.BBT.com
For 15q���J�r�
1:0531011211:00051983859SIB 66
316E
66-112/53
Date
$ yDa-c'0
Dollars Fr: