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YOUR LABEL NUMBER SERVICE STATUS OF YOUR ITEM DATE & TIME LOCATION FEATURES
70091680000237981117 First -Gass Mail ' Delivered December 02, 2011, 2:27 pm LAKE Expelled Delivery By:
WACCAMAW, NC28450 December 1, 2011
Certified Mail ry
Return Receipt
Notice Left
December 01, 2011, 5 04 pm
LAKE
WACCAMAW, NC28450
Arrival at Unit
December 01, 2011, 9:27 am
LAKE
WACCAMAW, NC 28450
Depart USPS Sort
December 01, 2011
FAYETTEVILLE, NC 28302
Facility
Processed through
December 01, 2011, 1 51 am
FAYETTEVILLE, NC 28302
USPS Sort Facility
Acceptance
November 30, 2011, 11.08 am
OCEAN ISLE
BEACH, NC 28469
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U.S. Postal Service Tm
CERTIFIED MAIL,_ RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Sent To 11e,12c4'-4,ors
---------"----------
Street, tNo; ------------------------------
or PO Box N.
60(, 16- 7 -----------------------------
- --------------------------------------------------
Imimm-Imm
RECEIVE1
DEC 12 2011
DCM WILMINGTON,
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
)roperty located at L04 S I {� "-., -1-1
V��Itict- -S(T—.
(dame of Property Owner)
I
I-I��)(Lot, $dock, Road, etc.)
)nWV`� , in , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:'(O - S3 �o 3 5-3 Mai ing Address: 4 0 , 6o x /5-K
-2a(1 0t4g ,OO'C , 2
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
DEC 12 2011
K)CM W'ILMINGTON, NC
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writin
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at (910) 796-7215.
No response is considered the same as no obiection if you have been notified by Certified Mail
(Pr e Ow Information arian Proper Own formation)
Signa re S ature
� I L. i J On � . ✓d lc� {�
Print or T pe Name Print or Type N4ne
Mailinp- Address Mailing Address
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director
Authorized Agent Consent Agreement
William G. Ross Jr.
*" CCkxV XLy
`ate. is hereby authorized to act on my b
(Printed Name of Agent)
order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited
►ecific activities described in the attached sketch.
)CATION OF PROJECT:
;OPERTY OWNER MAILING ADDRESS:
` 1VE[
DEC 12 2011
OCIVI WILMINGTON
`�i
�cf-kV\ (S LK- k- ( �q (,, PHONE NO. --1/0 -
THORIZED AGENT MAILING ADDRESS:
o22�?,7—rnesRc
co/sue ��y
QbYOq PHONE NO. 9(0-S3�-- q73
DEC 12 2011
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K.11 ►� )I"C', so-,y
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,-oSs "A
-RECEIVE
DEC 12 2011
C)C'M WILMIfi GTON,
C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: Kau W I
te:
l
Permit #: 5-�-Sgq I'll
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
Rat 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 ❑ RIX Both [IOther ❑
53
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Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other oil
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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 ❑
SOUTHEASTERN COASTAL CONSTRUCTION CO.
157 ROGERSVILLE ROAD
WILMINGTON, NC 28403
PAY
DATE/21—/2^/t
79C
67-7194-2;
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FIRST FEDERAL99 /4r91 lti
FOR
II'0079031I' 1:253271J' 170C30L54281I'