57375D - Sloan

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to �• J `ate h�'`� KS
/ (Name of Property Owner)
property located at Ad ee4, 0— �` rz—)
(Address, Lot, Block, Road, etc.)
on C�11 ifGS �—,in -�qms Fegra,j , N.C.
(Waterbody) (Town and/or County)
He has described to me as shown in the attached application and project drawing(s), the development he
is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
�avS dC 6;x/.N� �r
Print or Type Name
91z� - 3 9?-, � 5
Telephone Number
/- 1 - ZZ -

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to c��!' �i41r'��514 Ce4- oAb s
/ (Name of Property Owner)
property located at /fig 4�dQ✓ A&W - �, St4 ON* , l GQJyi S�•ir�
//���� //- �r (Address, Lot, Block, Road, etc,)
�n l�/ k_5 �GG /� , in lS�/S!
N.C.
(Waterbody) (Town and/or County)
Je has described to me as shown in the attached application and project drawing(s), the development he
s proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
i
Signature
Print or Type Name
!D•"54/7 ,2,qqc?
Telephone Number
n�*e

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Vacraei F. Easiey, Governor James H. Gregson, Director A lam G. Ross Jr.. Secretary
Date /13
applicant Name
Viailina Addresse�tG;g)d 7 Sv �
A114W -J� ds
I certify that I have authorized (agent) C OaS 7 I)re Aj h Si to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location(eA- A -yjep%-a/5
This certification is valid thru (date)
Signatu

Division of Coastal N19t, Habitat Impact Computer Sleet
I
3licant: �I �� � Permit #:
le:
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
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/oi
temp impact
amount)
Dredge Fill ❑ Both ❑ Other ❑
20_Z
_S
Dredge ❑ Fill ' Both ❑ Other ❑ftb
61C V
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 171