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UG 1 2011 2:54PM THE FORESTIAND UKOUP
�v �, 11.1 Murra, . • .... . .
Severty E
Governor
910754717IU U. I L � �
E
North Carolina DeAartment oj.� mironment an
d Natural Resources
pivision of Goastai Management
James H. Gm9son
a Perdue Diteclor
Name of
owner's
L
V.1
Dee Freeman
Secretary
AGFNT AUTBOR28"ON F RM
Name of Authorized Agent for this protect:
owner APPIVi119 for Permit:
Agents Maiiing Address'
Address: / 9--
C
Alp
� t Phon91\tyrnbeF
6 ! ..Z���.
phone Number
G(C'o
9/� ^ qZq - SZ� C �> u ose of aPPIYrn9
behalfOn M, for the p rP
certify hat l have authorized the agent listed instave ll orrtconst uct the following
activity)'
for and obtaining all CAMA Permits necessary s
0,/n O
tmy property loca3
ted) at
This c�rtifi id thru e)
i 0 ate
Property Ow
igr►ature

X3.nr
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oz
F,� XS xr J ��

Division of Coastal Mgt. Habitat Impact Computer Sheet
icant: Ckyls
?/IVi
Permit #: �10 � a"
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat 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
OL—f
0-1�
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 ❑
7 ")r. V l ., I a n

Brenda Murr ° r 2897
(Mi f l "u. p 66-112/531
Pk. 910- 54-71�,,
1790 Deerwoo�fW
SuppG, NC 284 2-3 00
ON ERUf ELi $
BRANCH BANKING AND TRUST COMPANY
1.800-SANKBBT BBT.anm
/ � ti?Pua y -- NP
of V
fOR
40S3LO11211:000519L.SOOL321,20 897
KIM ANOEBSON"
O 2006 NBM Bahm, Stud os AG.
Hatlentl ClarkB

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
/`;tjj,
3V/ Al,
7;QaXi N& e2 7 37/
2. Article Number
(Transfer from service
A. Signature ,
X ❑Agent
❑ Addressee
�RLceivecl by ( Printed Name) C Dat of alivery
® /'
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail ;
❑ Registered ❑ Return Receipt for Men"MOO
❑ Insured Mail ❑ C.O.D.
14. P—*. ;_._ , _
7p10 2780 0000 3712 7717
PS Form 3811, February 2004 Domestic Return Receipt
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
/
l vL / Q P'(/ha &02),ee
AV
A.
e) ❑ Yes
o�-M-tsao
❑ Agent
❑ Addressee
B. eceived byI Print N e C. ate of Delive
D. Is delivery address different fro
m item 1? ❑Yes
If YES, enter delivery address below: ❑ No
-ftJ'(i[ 3. Service Type
// v j` p ❑ Certified Mail ❑ Express Mail
0�0 l / ❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7010 2780 0000 3712 7700
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