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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
Authorized Agent Consent Agreement
William G. Ross Jr
�)U"NI F1 , t& I-,j is 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 limiter
>ecific activities described in the attached sketch.
OCATION OF PROJECT:
ROPERTY OWNER MAILING ADDRESS:
AUTHORIZED AGENT MAILING ADDRESS:
lKI\\0 'MR EM, I
J � 1
�ignature of Property Owner:
RECEIVED
JUL 2 5 2011
DCM WILMINGTON, NC
PHONE NO.9�7[ --4 V I
PHONE NO. 6`J6 _q U

DIVISION OF COAST -AL NLkI`T4GE1`SNT
I'f T 1 • Tr �. �. �_ __ _ _
Dame of Individual Applying For Permit: z�
i
I
Address of Property: I (U Oq F-k tr (, �'�, J
(Lot or Street -4, Street or Road)
M.
(City and
I hereby certify that I own property adjacent to the above -referenced -property. The inc
applying for this permit has described to me as shown on the attached drawing the developmi
are proposing. A description or drawing, with dimensions, should be provided with this 1(
I have no objections to this proposal.
If you have o jections to what is being proposed, please write the Division of
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-39
within 10 days of receipt of this notice. No response is considered the same as no obje
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift n
set bck a minimum distance of 15' from my area of riparian access - unless waived by i
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement. v
Date JUL 2 5 2011 —
DCM WIL"-,A

DIVISION OF CO AST MAN AGEl\4-F.NT
Name of Individual Applying For Permit:
Address of Property: /� 0� ±u f jl dP�
(Lot or Street -r"r, Street or Road)
n
(City and
I hereby certify that I own property adjacent to the above -referenced -property. The in&
applying for this permit has described to me as shown on the attached drawing the developme
are proposing. A description or drawing, with dimensions, should be provided ;vita ;his Ile
I have no objections to this proposal.
rA-
If you have objections to what is being proposed, please write the Division of C
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-39',
within 10 days of receipt of this notice. No response is considered the same as no objec
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift m
set bck a minimum distance of 15' from my area of riparian access - unless waived by n
you wish to waive the setback, you must initial the appropriate blank below.)
Si'la Name
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
OrC:EIVED.
Date
ACM WILMINGTON,
D,-:-+ XT.._-

C Division of Coastal Mgt. Habitat impact Computer Sheet
�Iicant:' � � Permit #:
:e: /
/Z///
7
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)
t-t",
Dredge ❑ Fill ❑ Both ❑ Other V
12,0
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 0 Both ❑ Other ❑

7984
JOHN H KING 66-112/531
130 E 13RANDYWINE CIR
WILMINGTON, NC 28411
AY s
BRANC N BANKING AND TRUST (,DMPANV
1.800-BANK BBT BBT.00m
1:053 10 112 Li:0005 2908 L7 25 211-0798L'
H.iien�l ,;laikn .