55823D - Russell

'CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #.
!flew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 1-7'J
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC //7, /ZG�/
Pl(ules attached.
nt �Njame "eJ R V SS < << It Da W," A lVOQ �y Project Location: County �,Q U /YSG✓/C,�
s/ _ .2 / '�90 *, I-iwk r •sf . Street Address/ State Road/ Lot #(s) ss9m e
eAp 1,F BiACState/YC ZIP27y49
}'a ) 5 75 - 75 -C Fax # ( )
edAgent
Adim C�,LdPIjJ
CW
LL W F�trTA 9-Eg- ❑PTS
OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS:
❑ FC:
yes i no
PNA yes / no Crit.Hab. yes / no
Subdivision
City 2'- g, ' P 6'?ae� ZIP
Phone # ( ) MRiver Basin L
Adj. Wtr. BodyC'Fr✓2 L Gtt- /Gt/Gri (nat
Closest Maj. Wtr. Body
of Project/ Activity L o Y ;
(Scale: l ;
lock) length
-m(s)f �S q
pier(s)
length
camber
.ad/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards
amp
)use/ Boatlift
Bulldozing
16 X p
ne Length S�o
not sure
yes
C9-1' 1h Vi
igs: not sure
yes
)rium: n/a
yes
f
no
Attached :X
��;
no
ling permit may be required by: OCcA, "
❑ See note on back regarding River Basin

I Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
I Print your name and address on the reverse
so that we can return the card to you.
I Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
A. SIwAture
1:1 % " * 1� " A ' 11 Agent
0 El Address,
B. ?cely4by (Prnted Name.) G D e o Delive
D- Is delAry address different from item yei,
If YES, enter delivery address below: 0 No
3. Servi Type
=,rtified Mail 0 Express Mail
0 Registered El Return Receipt for Merchandi:
0 Insured Mail 13 C.O.D.
4. Restricted Delivery? (Extra Fee) 0 yes
Article Number 70091 1L80 0002 3793 6100
(Transfer from service label)
S Form 3811, February 2004 Domestic Return Receipt 102595-02-M.-15

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, St-reet or Road, City & County)
applicant phone #: q10 , �� �_ Mailing Address:
:Ea.,,x . rV C c2, Pub
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
:hey are proposing. A description or drawing with dimensions must be provided with this letter.
A%` have no objections to this proposal. I have objections to this proposal.
f 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
,esponse is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
ninimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
vaive the setback, you must initial the appropriate blank below.)
6-1 do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
Property Owner Information)
,ignaturx
Came _ nc�
Tint or Type ame
(Riparian Property Owner Information)) ,
Signature '
A16r? t
Tint or Type Name

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
.. '-in ­',
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAI R FORF
Name of Property Owner:
Address of Property:
(Lot or Street #, Strut or Road, City & County)
Applicant phone #: Mailing Address: 7 2 Z at., n n Lu k �
(., '�4( (001
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.nccoastaimangementneticontact—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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
Signature !-0r,,., class
A --a r
Print or Type Name
Signature
Print or Type Name
Mailing Address
L.G�c i ri rr`t
Mailing Address

Ili
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NAS
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
leverly Eaves Perdue James H. Gregson
)overnor Director
Dee Freemai
Secretar
AGENT AUTHORIZATION FORM
Date: ao \
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
wner's Mailing Address:
L�-
Agent's Mailing Address:
hone Number (CAQ.Phone Number (q0)
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located) at L�,,,�r►�. r.. �-�ro �'^5�� I�'L
f his certification is valid thru (date)
Property Owner Signature Date

`
�
/
`- /
Lo

nlicant:,)7iilrnof I�vSSe'C v �/�� Ci:t'�'�y
Permit #:
:e: d G
3,,l
Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
nd in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fin,
�itat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration ands
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
�p
L 1l
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
. Postal
MAIL,, RECEIPT
U.S.
Postal:.RTIFIED
Mestic Mail
Only; .•RECEIPT
CERTIFIED
(Domestic• Ins
..
only; • ..e provided
t .<
FII
Postage $
Er
Certified Fee I
� Postage $ "+
M
tum Receipt Fee Postmark
Certified Fee
ament Required) Here
O Receipt Fee Postrnerk
led Delivery Fee
Ratum
(Endment Required) g.. , ..I ! Here
>ment Required)
OO
Restricted Delivery Fee
(Endorsement Required)
�
'ostage & Fees �
CID
. A Total Postage & Fees $
iPt ......_
Sent To
Er
�x
Sliest, A P
a
or PO Boy
City Steh
:rr August 2006 See Reverse for InsfrUCtions
Dredge ❑ Fill ❑ Both ❑ Other ❑
r �.
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ITS BETTER BU][][aT INC.
4287 C.—I,. A—
S6aliotte, NC. 28470
[phone]
' ,P5N c P>�-J
553a3
iia00 L8 36iia
First Bank
Shallotte, North Carolina 26470
66-456/531
1836
DOLLARS
M
:0 5 3 10 4 5 68i: 7 9 1000 2 2 Sill