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'CAMA / DREDGE & FILL
ENERAL PERMIT Previous permit#
New Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
rie-41 by the State of North Carolina, Department of Environment and Natural Resources h
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC d
es attached.
t Name L A/C' % ff, 11' A-' x Project Location: County z cy ,:S w r C k
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CW EW ❑ PTA ❑ ES ❑ PTS
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❑ PWS: ❑FC:
yes / no PNA yes �_ Crit.Hab. yes / no
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Phone # ( ) River Basin
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El See note on back regarding River Basin
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47
IN

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL IL�NAGEMENT
ADJACENT RIPARIAN PROPERTY OVY ER STATEMENT
f P rt Owner• L
1t
Blame o ropey
address of Property: J- _—
(Lot or Street #, Street or Road, City &County)
Mailing Address:
Applicant's phone #;Y==�_T_J�: o n�
l� t Y C-
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pej
has described to me as shown on the attached drawing the development they are proposing. A description of draw
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 (DC
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response v
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 distanc
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Infor ation)
Signature
lea_
Print or Type N e
o -S C-+ T) .
Aif�;I.- r A AArocc n
(Riparia Property Owner Information)
Signature �%pe
Tr n
,� '9, C'�cu, �.
Mailing Address

F,om—' edai Rehad 'ita-lon 8436613013
04+'9:2011 11'1.34
# 23')
OJ2100?
CE1kJ1F1EQ -NLUL - RETURN RECEIPT REDIEST
DIN'ISIO'N OF COASTAL MA-NAGUMEXT
ADJACENT R.I�PA
-�,RiA` PROPERTY OWNER STA UML-N-f
'_v3zne of F: ;perry i}wrt .__/
rTAddress of Propem
(7 Ot cT Street h, Street ter Road, City & CouEJ`.-):}
Applicant's phone
r
!hereby certify tftat I owrt properr/ adjacent tc the above referenced Property. "The indiviauai applying for this pMrnit
has described to me as shown on fife attachzc4 drawing the cieveloprucnt the are prapos r1g. A�_esczip'- noo�ziL3wi;�g,.
w r di d-lions. tg� _1a .McLylt ed witi�tLij
I have no objections to this proposal- --,,,_. I have otaject nns to this proposaE.
If you have objections to what is being proposed, you mast notify the Division of Coastal Manageurent (DCYf1
in writing within 14 days of receipt of this notice_ Cormspendetice should be maAled to 127 Cardivai Drive Ent
Wilmington, NC U405--384& DCM representatives can also be contacted at (910; 794-7215. No response is
considered the same is nr nbieciic+n ii'you have been notified by Certified 144ai1t-
WAIVER SEC1; ION
I understand that a pier, dock, m xtrir►g pilings, breakwater, isoatt►c�use, vs ;ift must be lei bar k a r^in;mtit.: dis:a;'=ce f
15' frc- n my area of riparian acce:;s unless waived by me. (Ifyou to waive the setback, you must inatiai tFc
appropriate blank below.)
I do wish to waive the i" set back requirement
I do not wish to waive the IS' set back requirement.
(Riparian Property (>vner• .Information)
{Property Owner Information)
Inatur0
Print or Typa :.i' e
q3 0 -
ailing Address
City Stec 1 Z
� eleytsoae Number � __
Signature
Prue or Type Name
Maiiilig Address
rit} I Stale; Zia
'Telephc,na tiurnber

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3everly Eaves Perdue James H. Gregson Dee Free
governor Director Secrf
AGENT AUTHORIZATION FORM
Date: c2 /'
ame of Propertv Owner Applying for Permit: Name of Authorized Agent for this project:
ain S ZAM
JW_trh Y , /11,+ ! l y
iwner's Mailing Address:
13 16 P rUf.JIC I
U l n rY G.
'hone Number &,T4)
Agent's Mailing Address:
Phone Number J/d)-,57—`7 3�5
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or
and obtaining all CAMA Permits necessary to install or construct the following (activity):
b t� -�1d"i10, do A w.IA 2 4-,c-"Ch-01 51XlZ �- D nPLl
r
-rCt
ck
'my property located) at eG
This certification is valid thru (date)
r44
a nnnriv Ow" . ' nature Uate

icant: c/ i 9 �� , G'✓i��i �9otif
�12
Permit #:
:vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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 fina
disturbance.
Excludes any
restoration and/i
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other ❑
/6
2,14
Dredge ❑ Fill ❑ Both ❑ Other
�!/
Ye7
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 ❑

JOSEPH V. MILLIGAN M-7143/2531 5460
LARA R. MILLIGAN
NCDL 4319111 4299734 DATE `7
P.O. BOX 131, HWY.130 PH. 754-9345
ASH, NC 28420{
PAY TO
6 TH RDE OF
DOLLARS 8 o"d°i°i.ae.x
Y
3 �
SECURITY
SAmNGs BANK
Shallotte, NC 28459 %,
r7 MEMO lru� [ ml n;�
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