55822D - Tucker

1CCAMA / ' rOREDGE & FILL
GNERAL
EPERMIT Previous permit #
w ❑Modification L,Complete Reissue El Partial Reissue Date previous permit issued
iorized by the State of North Carolina, Department of Environment and Natural Resources l /
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
� -- /� LQ,RMes attached.
/ m Name / M �/! r �c L 7? Project Location: County
s Street Address/ State Road/ Lot #(s)
}r l Statel (' ZIP 2y 69
# "d S' '%S V Fax # ( ) Subdivision
ized Agent %V ©-� City �� P� r' L P &q, {/ ZIP 2
d ❑ CW L-?M J9-PTA '-EVES ❑ PTS Phone # ( ) River Basin L V
❑ OEA ❑ HHF ❑ IH ❑ UBA N/A Adj. Wtr. BodyL'W �wNd �2�° P.� C9at
El PWS: ❑ FC:
yes / f _0 PNA yes /� Crit.Hab. yes / no Closest Maj. Wtr. Body 4tl
A Project/ Activity to w ,/?11 Ile) 0,9�
(Scale:
lock) length
length
umber
;ad Riprap length
l �
vg distance offshore
nax distance offshore$ —
channel
ubic yards_
amp
)use/ Boatlift
Bulldozing
4,
ine Length y
not sure yes Chg-
igs: not sure yes
)rium: n/a yes C` % 5 `1 tiJ• SS �. % 5 �� W . S� t i
lt3, no
Attached: yes Q
Jing permit may be required by:
I— . . — .... r/ - . - s u 1
ANC
/w0 W. 3-`tl57-,
❑ See note on back regarding River Basin
i - -/ D / // L -., l

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Frei
Governor Director Seci
AGENT AUTHORIZATION FORM
Date: 5 ' _
Jame of Property Owner Applying for Permit: N e of Authorized Agent for this project:
4A ,-0 C00pk-2t`
owner's Mailing Address:
G
J 13 r�1 c �g i
Agent's Mailing Address:
P go 3
5ha1 L 2g 5
'hone Number (70� .5 %2�` % Z Phone Number (T /) �� 3` 192
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at Zc+ 4V TS6 /6-1.1- W. S4L r� 018 /V e
c
This certification is valid thru (date)
343a0�
.i •ine�r Cinr� ����o natP

r /Lb-ti.clr � c� �/� ✓Gry
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T m (U C Ke-(- is
(dame of Property Owner)
property located at Lot (9(� The (�eSOr+q 0,1K 15 -2, W
(Lot, Block, Road, etc.) rr
on 014 S.,in O i�� I Br0N!U WICk Co. N.C.
(Waterbody) (Town and/or County) 1 / J
Applicant's phone #:��-5 -7��"I Mailing Address:p©, box rvI3 I
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:
Bl d
(To be filled in by property owner proposing development)
e����
-------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) `" l
PL, V n1C 7 3 Z.uant. oC�►-- �a�7�
Mnilinrr AA Ir— Ci nn 5thirP

03/23/2011 15:15 7145488862 OFFICE DEPOT PAGE 02
U`f ~ d L 1, vy
ADJACENT RIPARIAN PROPERTY OWNER STATUN.tENT
I hereby certify that I own property adjacent to ---
(Niame of Property Owner
property located at Tkc (esorl�c �B,
(Lot, Block,:Road, etc.)
f � (
on in 0,T
(Waterbody) (Town and/or County) 1-�f �
Applicant's phone �:� �7 .�7JI _ Mailing Address: �, ���_.(rl 3�---
He has described to me, as shown below, the development lie is proposing fat that. loc',ttiion, and. f.
Dave no objections to his proposal.
DESCRIPTIOti AND/011 DRAWING OF PROPOSFD DEVEI..OPKENT:
�VkkeAd (2i/ Oe filfcu in Oy ()1vPC, Ly urvnc, //, vj.1wdr&r, .&, "Vjv... .. .1
(1oformatiot) for :Property Owner Applying (RipariaLn rope rty Owner Information)
far Permit)
Mailing Address Sig naturc

Dplicant: / �. %� L/<P� Permit #:
ate:
3�2y��
,scribe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
and in your Habitat code sheet.
ibitat 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 fii
disturbance.
Excludes any
restoration ani
temp impact
amount)
•L
Dredge ❑ Fill Both ❑ Other ❑
y2
yZ
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 ❑

RYAN D. COOPER
NCDL 8375610
PH. 910-443-4829
P.O. BOX 1393
SHALLOTTE,�NC/ 28459 DPEIAV
�
PAY TO / �/
F,Ar.C)RDER OF 1
66-n04/2531 9289
DATE 2q—,
$ qoo �
State Em to ees' Credit Union® _ 0-IR 55 ao at
Supply, North Carolina
81 M
MEMOI itj3rd—L--k—e-4
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