56635D - Yankalunas

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
� 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on . �C od , in ' r , N.C.
(Waterbody) (Town and/or 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To befilled in by individual proposing development)
Print or Tvne Name

Ill 10:56a Fussell
[phone] p.1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to A11 �jaw .. l�,,r`�? —'S
(Name of Property Owner)
property located at
(Lot, Block, Road, etc)
on �i�lClPG.G , m —,/� N.C.,
(Waterbody) (Town and/or Coaaty)
He has described to me as shown below, the development be is proposing at that location,
and, I have no objections to his Proposal.
DESCRIPTION AND/OR DR WLNG OF PROPOSED DEVELOPMENT
(To be filed in by individual proposing development)
j'yt v'�ii G
C-W'0
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Print or Type Name

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Govemor James H. Gregson, Director William G. Ross Jr., Secretary
Date 13 - j - 0�0 I D
Applicant Name V I J f; a ,y \.I/ -1 kq 1%/7 9 S
Mailing Address ( py C s�2 a , ` � Q 1. k P -L-
I certify that I have authorized (agent) ff�AAC C eM >'1 -lf_ to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location)
This certification is valid thru (date) ) (' `- ) - q'ID I
Signature II 'kU

C Division of Coastal N19t, Habitat Impact Computer Sheet
nlicnnt.: 'Xiw Vyt&,I, Permit #
le:
h
Scribe 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 ❑ Both ❑ Other X
y
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 ❑
I '�2,1 „

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CLEMENTS MARINE CONSTRUCTION INC ® 2243
112 CIRCLE DRIVE 910-270-9110
HAMPSTEAD, NC 28443
56-30/531
f ✓ ( 365
Date
Pair
First Citizens
Barl
i
For 'Sgwo so
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1:0 5 31003001:003S320814S8u' 02243
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COASTAL VIEWS*