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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date 'Y—.2L�' I
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) �- r `,5�- Xa,*�'I 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)
`f 72L.
Date

429/2011 11:25 3366651809
)r 29 11 11:25a Buddy's Jewelry
MARTINS SYSTEMS PAGE 01
91 "58-5039 0.4
1a:=
L! (e
f'11 Ndoress
Ci), State..zip Cade
bear Adjaccr.l:- operty,
This istier is ,o Mum you that i, ,� 'S "f.i /-c r,c r have applied for a LAMA
Propeny Owner
Fetm! or m/ property at o(��' {74eAl%es"
Properrf Nddres!
.A- required by :,AMA regulatoni, i tsve erciovst a copy of MY permit apphWb0- and project clramnc(s
as notincaaon of rry propped aroj= W action, is re*W91 from you Or You may sign anro m1u~n no
enclosed m abjection form. ii you have en) quemis or commerim aloof my .=oms4 ort js - p►ame
Contat me at / 9 -!� �~ :.= �.or by nail at ;he adores; iisted belau. r ym: tiris`t to
Appiicanft TabN om
file w1tmr, cornmerb or obje?-.torts whn the Town cf le Cry CAWS War Perrot pmgrarn. you May sutr
them to;
Chrisara Watkins
Local; Permit Offar
TJwn of SuO City
P,G, Box 247E
Surf City, N:: 28445
SinpQ�ai�n

1/29/2011 11:25 3366651809 MARTINS SYSTEMS PAGE 02
>r 2911 ? 1:25a Buddy's Jewelry 919-658-5439 V
S7t,"EMEW
Na :)Bi E "ION
narsoy mrriv in al ! owr oTopely adia::9r,, t..,.� btii�-s' / / ee f--ye
- (Norne &Prapenr owner,
pr;,pem loemac, at Z E� �LA� ?- CT:
y �1
(MQ OfraS;
cr. - in Sur City, h.C.
(Watemody)
He has described to me as shown in the ettachcd epplication and project drawing (s),
the development he Is proposing at the above referenced location, and, I hove no �
obiec6ons to his aFo
.ITT, rr►•.-� ,� sh..ti.. P. nil;.:
h1t cr Type Name
lob )W._s d;
336 I(897 �A
Phore4 Number
Dace �� 1 r
Return fom to;
Town cf Surf City
Local Permh offe;.er- Christina Watkins
P.C. Box Surf City, ►JC 28445
(910) 3215-4131

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIAIOORING PILI_NGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to --F`2 0'"W 5
(Name of Property Owner)
property located at � �,L /y /t � S
(Lot, Block Ro 0 etc.)
on , in -hn. , N.0
(Waterbody) ( n and/ r County)
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 (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.)
e-tFdo not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in wr
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Eat. Wilmington, r
DCM representatives can also be contacted at [phone].
No response is considered the same as no obiection if you have been notified by Certified Mail
(Information for Property Owner/Applicant (Riparian Property Owner Information)
Applying for permit)
6-& 6-3/
Mailing Address Signatui
21 tPOA119a
City/State/Zip Print or Type Nan

Division of Coastal &19t, Habitat Impact Computer Sleet
��
Acant'T�n � t uY"*,--
e: 5/ 51
t
1
Permit #: 533Z+D
;tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat 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)
Dredge ❑ Fill IxBoth ❑ Other ❑
4
Dredge ❑ Fill Both ❑ Other ❑
5
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 0 Fill ❑ Both ❑ Other ❑

LIGHTHOUSE MARINE CONSTRUCTION INC 4099
PO BOX 2532
SURF CITY NC 28445-0028 /
DATES J 66-19/530 NC
PAY 111 702
TO THE
ORDER
ORDER OF
Bank of America '10oF10,
ACH R/T 0530001 BS
111004099110 1:053000 L961: 2370054 L588711e