57425D - Sullivan

CAMA / [ : DREDGE & FILL
i" E N E PAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources -4' ( co
oastal Res ,,jces Commission in an area of environmental concern pursuant to I SA NCAC
i
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zip
Fax # ()
ed Agent "'� 4�I lY i1E t1Jc!ey"S
_
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❑ CW EW APTA ❑ ES
❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ USA
❑ N/A
❑ PWS: ❑ FC:
yes /( no PNA yes) no Crit.Hab. yes
Project/ Activity
1-th
Rules attached.
Project Location: County5YI/►15W i ai-
Street Address/ State Road/ Lot #(s)
-354-0 Niwman Uyl Yc. Sw
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Phone # �G )8q
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ling permit may be required by: ❑ See note on back regarding River Basin i
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R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee Freeman
Beverly Eaves Perdue James H. ctor n Secretary
Governor D�ect°r
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project. \
Owner's Mailing Address:
7I/ � t
S
�Teo fft N
Phone Number 610 1 S- 3'x/ b S
Agent's Mailing Address:
c�h
Phone Numbery�
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMAnPermits
/necessary to install or construct the following (activity):
r,fIW1n4 D_-F ES/nILChe4
(my property located) at S7 0 f h �a
This certification is valid thru (date) _ �1
Date
Property Owner Signature

NAND DELIV
ER '0°CK - soatt L-F-f- - ler
ADJACENT MRNU �O PIL N�o PTIBDATHOUSEE)j NT
(FOR A
am
.. vac s
1 hereby certify that 1 own Property ad}scent toAe-of Proper'ty Uwner)
property located at aS"?0/t b2~ &.y ' "
(Lot, Block, Road, etc.)
on �k1�l�fl �'Ur r N.C.
, in �1��nSW �ol�'► ,
(Waterbody) (Town and/or County)
Applicant's phone lt: q� � y � Mailing Address: Z�Z
e He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (151 from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must jai the the appropriate blank
below.)
1 do not wish to waive
I do wish to waive that setback requirement.
---------------------- --
---__----------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVET.APMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
o �t ►n 54, iV�n
Mailing Address
7l/ T 4M
City/State/Zip
(Riparian Property Owner Information)
xz� r
- -- - Zgnature
print or Type Name

4
HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 50— kl, YC'11 rom 's
(Name of Property Owner)
property located at 3Sr70NOr
(Lot, Block, Road, etc.)
2
on s lja C Lf/t , in &/Wt�W t Ck C - , N.C.
(Waterbody) (Town and/or County
Applicant's phone#; 7277TY Y7W Mailing Address: 4 t,
//,6Ar /U
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
ill T � -
Mailing Address
5Z4//Q /tic. ,7
City/StatelZip
(Riparian Property Owner Information)
Signature
--Print or Type Name

NAND DELIVER �u(Kke
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
l-►r ,�
I hereby certify that I o4_Nni property adjacent to _°.I.t eya h s
//��
(Name of Property 0"cr)
property located at _,3 �d'jy!' � A 6/ Sw �N_-- `I `— (f
DD� (Lot, Block, Road, etc.)
in W t G/C : N.C.
(Waterbody) ('Town and/or County)
Applicant's phone th ��% �y� Mailing Address: 7//���t` --
e 1tic�_8`
He has described to me, as shown below, the development he is proposing at that location, and. I
have no objections to his proposal.
-------------------------------------------------------- ------- ----------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
- ----------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address
City/Stateizip
Telephone Number
Signature
Print or Type Name
ql0- S_o a - 106, - -
Telephone Number
nM-

ADJACEN' RIPARIAN PROPERTY OWNER STATEMENT
1B -d� (F,O,RAPIEWMOO.UNGPIf-IIVG,51POA'r[,IFT OA"r�" j�M
41 t
I hereby ccr+jfy that I own propevILY adJacetit to *1/
I . I A(Nj ake 0 1 �-� e r ti T'l 11-1)
property located at .-Scam-
(Loi, Block, Road, etc.)
011-S/O —, in
Il'off (If,
(Watterbody) (Town and/err Count
Applicaut's phone 9:_tlP"v%�-YMIO Maffing Address: .?/1
5—AAM&C
Ile has described to mc, as shown below, the development lie is proposing at that 10c,1110", and, I
have no objections to his proposal. I understand that a pier/Mooring pilings / boatlift I bmithoustt
MUst be set back a minimum distance of fifteen feet (, 5,) from my area of ripariati access unless
waived by me. (I you wish to Nvaive the setback, you Inust inifivl the appropriate bkzuk
belo-e—)
,46 1 do not wish to waive
I do wish to waive that setback requirement.
----------------- --------- 7 ------- - ------------- ---------- -
DE SCRIPTION AND/OR DRAWING OF PROPOSED DEVtL0PP4FNT:
(To be filled in by individualproposing developmen!)
-,4114 a/ e d111
- - ------------- ------- ------------- -----------------
(Infortnation for Property Owner Applying
for Permit)
Mailing Address
S411,oke Ne-2WV70
citylstatclZip
-.2
Telephone Number
(Riparian Propwrtv 5"formatioxi)
-A-4
Print or "ivot Name
Number

Division of Coastal Mgt. Habitat impact Computer Sheet
cant: (-�hlr1 Sj
13/4 140/ � \
:vibe below the HABITAT disturbances for the application
d in your Habitat code sheet.
Permit #: 5--i4+a 5 (�
All values should match the name, and units of measurement
tat 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)
i�
Dredge ❑ RIX Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other
0
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 ❑
fir, �l - ,

ol

MARITIME BUILDERS, INC. 12-06
910-842-3625
115E ISLAND DR.
OAK ISLAND, NC 28465-7612 J
j� DATE
PAY / ( �G/
TO THE �
ORDER OF
Batik of America��
IACH R/T 05306
Ic
FOR `
1.
u'00 2 2 3 7u' 23
i
7000 586 384u'