54584D - Davis

74CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
New []Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC j 4,
-� Rules attached.
nt Name l V i 5 Project Location: County *- ii.. tiLLO I C IL-
s .�j" 7 of V lC EUy, Gr- Street Address/ State Road/ Lot #(s) ( I 6 SE I
of State K)t ZIP iG cl�
3(vl- -WS .�—. =
�' � Zb Fax # �- @ rrr-T�—, .
zed Agent ' n1 ✓ti Y ✓, _ /ktv1iei i (OJ
❑ CW ❑EW E PTA 1PfS ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
Subdivision
city Om-wL, /S (-d&O ZIP-
Phone # ( ) River Basin
Adj. Wtr. Body rnat
yes / no PNA yes / no Crit.Hab. yes / no
C_ Closest Maj. Wtr. Body i w lry
of Project/ Activity Vi� L 21 L;lL Iti/ (LIAO) 1,Li ii"- T PC NT-L I jL -
.- - - - - (Scale:l /ice
ock) length > O X' J
m(s)_ 1�� X 12 I !X
pier(s)
ength
umber
ad/ Riprap length
ig distance offshore
iax distance offshore
:hannel
jbic yards
imp
,use/ oath x 12
�SE�'�C. Cw�ttl�r
Bulldozing
ne Length
not sure
yes
fi0:
gs: not sure
yes
/(io
,rium: n/a
yes
yes
ho
Attached:
.yes
no
ling permit may be required by:
❑ See note on back regarding River Basin r

American Fish Company
P,O, Box 11046 „
Southport, North Carolina 28461•
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�r . American Fish Compla
P.O. Box 11046
J, Southport, North Carolina 28461
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
James H. Gregson, Director
Authorized Agent Consent Agreement
William G Ross Jr.,
is hereby authorized to act on my bs
(Pnntel Name of Agent)
order to obtain any CAMA permit(s) required for the property listed below
ecific activities described in the attached sketch.
)CATION OF PROJECT:
tOPERTY OWNER MAILING ADDRESS:
ai�7�1�7m
r , C
.1564,
1THORIZED AGENT MAILING ADDRESS:
o (INOgc;c��e cd,
The authorization is limited
C�,q _36$ - L4�' 2F�
PHONE NO
PHONE NO. 910-qS 1- 5 &M
;nature of Property Owner:

10:94576551
- - — .►. i�.r�l tv�wAlvt.KrGR
Name of Individual Applying For Permit; nn �a�t S l is-369 -Y52E
Adcress of Property:
of or Street 0, Street or Road)
-OG K S 5` r Ai\5 cc A Co
and County)
I hereby certify that I own property adjacent to the above. refe►erced property. The in
applying for this permit has described to me as shown on the attached drawing the dtveloRn
are proposing. A description or drawing, with dimensions, should be provided with this I
_ -X _ I have no objections to this proposa
It' you have objections to what is being proposed, please write the Division of
Management, 127 Cardinal Drivo Extension, Wilmingon, NC 28405 or call 91ni.71
within 10 days of receiptofthis notice. No response is considered cite some as no obje
you have been notified by Certified Mail,
WAIVER SECTION
I understand that n pier, dock, rn;ooring pilings, brenlovater, boat house or boat lift (nus
hc{: a minimum distance of 13' from my area of riparian access - unless waived by me.
wish to woive the setback, you must initial tho appropriate blank below„
;.�.°.._.,�1 do wish to waive the 1 S' setback reouireirter:
I d...Q.n2 Nish to waive tnc !>' sctbaek rtq!:ircm�n;
L)'Ue
�Ae� t-t►V� r �.soN L � , S oil
Print Name
AL A

10:94576551
Name of Individual Applying For Permit:
Address of Property-. I l 5 e kq t S ,�
(tot or Street ts, Street or Road)
(City and County)
hereby certify that I own property adjacent to the above•referencen proper.. The in
applying for this permit has described to me its shown on the ached drawing the developn
are proposing. A description or drawing, with dimensions, should be provided with this
�-// ` have no objections to this proposa;
It' you have objections to what is being proposed, pie -Ise write the Divlsifrj of
Management, 1Z7 Cardinal Drivo Extension, Wilmindtoti, ..NC "8405 or call 91` .7!
within 10 days of receipt of this notice. No response is considered ripe same as no objt
You have been notified by Certined Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, bronlnvater, boat house or boat lift mu:
bck a minimum distance of 15, from my area of riparian access -unless waived b%me,
to Woh-'e the setback, you must initial tho appropriate blank below„
do wish to waive the I setback require:r:er:
I dQ n2t Nish to Nvaive the i sctbock rtou!fGm:r,t
C?- 1-o - is
Tar-. Name Date
C� e j • �vb�C Gc��, Lf
nc �_ .�.Y/ � /U C
Print Name �'/�

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 111
�" V S
Date: -71A/ I0
Permit #: 94 SP f
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremf
found in your Habitat code sheet.
Habitat 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 f
disturbance.
Excludes any
restoration ar
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
b l
Dredge ❑ Fill ❑ Both ❑ Other CT"
2�
Dredge ❑ Fill ❑ Both ❑ Other Z/
I Q (�
t o o
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 ❑

THE AMERICAN FISH CO.
CHARLES H. OR KAREN Z. PERRY
P.O. BOX 11046
SOUTHPORT, NC 28461
PAY
TO THE
ORDER OF
First Citizens
Bank firsttcaizzens.com
.�0,a5�a /`-i�nl - -- ----
DATE _QZ I0
FOR
non A ? :k ? Iiie 1:0 53 100 300i:00I, 5 3 12099 2 211'
82321
66-301531
453
$Q, �O
DOLLARS