57587D - Thomas

AIF
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North Carolina Department of Enylron went and Natural Resources
Division of Coasts, Ma g Gee Freeman
rly Eaves Perdue names it ctor n Secretary
Director
nor
AGE T -Th1 HQ Via.. }� Fa_RM
Date: —4�-
of Pro erty ��wner Applying for Permit:
Name of Authorized Ag far this project.
t N
Hers Maflir:g Adire ss, l
one Number
Agent's Matitng Address:
Phone Number �i/o
t agent listed above to act on my behalf, for the purpose of aPP Yln9
;ettify that t hav4a authorized t tie a5activIt
obtaining all CAMA Permits necessary to install or constr_:ct the following ( I Y)�
>r and _ c ✓ _ �„ .: 3
property located) at
This Certificati 'd thru (date) -
i
Date
Slanature

• ,.I%'_'.�"'r""�r..i+,_t� Lr.:.� a J �� 1, y t l �ir' , ' ( + illy I~� �. ♦ ,• t.n
Applyinj r-Jr Parta%.tt: w.�1 °...�.�
Addr;ss of Proptrty.., ciIG L c PLo
(Lot or 5traet 4, street or Road) -
Cary and counr'y') _ .Y._.
I hereby certify that I own property adjacent to the above -referenced property, The inn
applying for this ,per rzit has described to me as BhMa on the afmched drawinj tie dcveiopmi
are proposing. A description or drawing, with diirensions, should E e provided with this IE
I nave no ob*tlons to this proposal,
If you have objections to wbat is being proposed, please write the ;Division of C
Managerrlent, 127 Cardinal Drive, .extension, Wilmingt(jn, NC 28408 or call 410-79,
within 10 days of receipt of this notice, No response is considered the same as no obieR
You have been notined by Certified Mull.
WAIVER SECTION
I understimd that a bier, dock, mouring pilings, breakwater, boat hQUae or- 1309t lift mull
bek a minimum distance of 1s, from my area of rlperiAn accost - unless wa wed by me, I
wish to waive the setback, you must istltial tr: ra rl blank below,)
,,,,_, i ��o wis:t to wei��e ;hc 1 S' setback requiretztent,
a ,yR„fig; with ►n w4iV6 thy; 15' iotb4ck requirement.

aApplyizi ,r t'trjsr:
l oNt�; S
Addr:ss of Pronar•c�,-, .......�..
Lot or Street, Straec at Road)
(city and counry.
0. a Yg11
I hareby certify that 7 own property AdAcent to the above -referenced property. The i.n�
Rppi}'ink for tris perr:�ic has described to me aS spawn on the ahched drswing tie develQ rr
CC propGsing, A descn' ' n or drawing, with dlinensions, should !�e provided with this i,
___ar_._ I have no objections to this proposal.
If you have objections to wbat is being proposed, pleuse svrlte the ;13ivision of C
Management, 127 Cardiaal Drive Ci stlnaion, Wilmington, NC 28405 or call 9I0.79i
within 10 days of receipt of this notice, No response is considered the sarnb as no ob e
You have been notified by Colt red 1M,a11, j t
WAIVER, SECTION
Y undersund that 2 Fier, dock, mouring pilings, brettkrvater, boat house ot- i)oat lift
bck a min imum distance of IS, frnrn my wren of ripArinn access - usalass wa�;ived must
'A'ish to WINI the setback, you must inititti tt� ro ri tc Munk below,; by me.
--�.-...r..,..�.... ? do wish ±a;he IS,
setdsck requirerr,ent,
S ill
d z «'ish cc� we,ive the 15setbtick req;tirarnart.
I I/ KV 2,0 � �
Date
Print Name

C Division of Coastal Mgt. Habitat impact Computer Sheet
plicant: �Glq�, -►z� S Permit #: -97
`e: M
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
iitat 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
im act 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)
WV
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

MARINE PIERS & BULKHEADS LLC
NCDL 3831595
6314 WRIGHTSVILLE AVE 910-256-6357
WILMINGTON, NC 28403
OVIA
Wags Fargo Bank, N.A.
17955
66-21/530
BRANCH 50004
DATE I i l
1110 1 79 5 S"m 1:0 5 3000 2 191: 2089 17 040
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