57422D - Tatum

CAMA / ❑ DREDGE & FILL
ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC j
i ules attached.
it Name pU v 1 '� , ) ,� Project Location: County DYVYISjAA CA,
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❑ PWS: ❑ FC:
yes / no PNA yes / no Crit.Hab. yes / no
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Street Address/ State Road/ Lot #(s)
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ling permit may be required by:
,��� 1� _ ( ❑ See note on back regarding River Basin
-4H 1-)tin A 0A /I It lfkfix Ir-7,0.

■ Complete items 1, 2, and 3. Also complete
Item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to:
Virgil L. and Rebecca Elvis
609 Jasmine Avenue
Myrtle Beach, SC 29577
> [0 Agent
O Addressee
by (PriAtgd Name) C. Date of Delivery
D. is delivery address different from fteM 17
if YES, enter delivery address beloir
3. Se Type -<- y — v
Certified Mail ❑ Express Matt---- —
[3 Registered ® Return Receipt for Merchandise
❑ insured Mail 0 O.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2, Article Number ?009 1680 0002 3?93 6049
(Transfer from service !abet) 102595-02-M-1540
PS Form 3811, February 2004 Domestic Return Receipt

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: ,
Address of Property: U 0 ��Ylr��' � Co�c, _=�s ( v•t.<. IVC-
(Lot or Street #, Street or Road, City & County)Yu.�s�
Applicant phone #: `� "► q3 �(]' f Mailing Address:
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. 1 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.nccoastalmangement.net/contact 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)
Signxrturc O-.rti,
Y
Print or Type Alamo '
Mailing Address
(Riparian
%Property Owner Information)
Signature
\J 0 C kla'� G<�e� I O'k-S
Print or T e Name
Mailing Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner: M a Y vtrY--
Address of Property: NL
(Lot or Street #, Street or Road, City & County)
Applicant phone #: ' "I — �1 -1 3 -- 3 33'-/Mailing Address: -2.)
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.nccoastalmangement.net/contact 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.
✓,rn-� I do not wish to waive the 15' setback requirement.
(Prope.qy Owner Information)
Signature o,-rs 4;r
Print or Type Name
Mailing Address
(Riparian Property
Owner Information)
�iC��it,C.✓ ��-a�.5 - m -t.
ig1nat c
Print or Type Name
rl � J
Mailing Address

38/08/2011 08:21 9105798507 RHMCCLURL
PAGE 02
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Names of Property Owner Ap`plly-iinng' for Permit:
.! t !2 y, 4 �A4 1 �h`tl.l ran.
Mailing Address:
I certify that I have authorized (agent) f—�-'� 0-on , �dorY to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
,
at (my property located at)
This certification is valid thru (date)
Property Ownei(ftnature I Date
cf ac,IC._
.4, NC

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tun
_1 D u � a

�11

Division of Coastal Mgt. Habitat Impact Computer Sheet
licant:
Permit #: F-H Pa (
ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
itat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount
Dredge ❑ Fill ❑ Both ❑ Other
I
1
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece
or on the front if space permits.
1. Article Addressed to:
A. Signature
X ❑ Agent
❑ Addressee
B.
Received by (PrOted (Name) C. Date of Delivery
D. Is delivery address different from Item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
Larry E. and Marguerite M. Wallace
11169 Hickory Ridge Road L3.
Harrisburg, NC 28075
Ice Type _.
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D. -
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(transfer from service label) 7009 1680 0002 3793 6056
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M-1540
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Zr-o - 0 s L (., ) ';� A

First Bank 1941
ITS BETTER IBT-7II)(,T INC. Shallotte, 66 456/53tNorth lina 28470
4287 (- mlpn A—
Shidl.ite, NC 28470 8/16/2011
[phone]
THE
OF NCDENR $ **200.00
Hundred and 00/100----- —...
NCDENR
C C T-�
5 Union
Its 00 L911 Lii' 1:0 5 3 L01. 5681: 79 L000 2 2 Silo
_ THIS DOCUMENT�CONTAINB A COLORED BACKGROUND ON WHITE I- ER. MIOROPRINT IS. LOCATED BELOW THIS WARNING BAND. _._
DOLLARS