55894D - Edge

CAMA / DREDGE & FILL
E N E RAL PERMIT Previous permit #
New "--I Modification --]Complete Reissue "Partial Reissue Date previous permit issued
rized 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
u es attached.
t Name 1 f-&a t/ �q�� Q S T Project Location: County ECV JJCV1Ck
S G 9 /`� L Ala k pa, Street Address/ State Road/ Lot #(s) �Q /
)yg Ai^ State ZIP �2_ _
(chi 9 y9'y/// Fax # ( ) Subdivision
ized Agent s [ %`j4 /* As City QC P Ar SL P ✓Ac �7 ZIP
d ❑ CW IHEW C4-PTA tfES ❑ PTS Phone # ( ) River Basin y
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Cej eAL D /��W (a< na
❑ PWS: ❑ FC: /
Body —
yes / o7 PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
of Project/ Activity y �a V 092 L.,9fL /S AF9C/ d'
(Scale: �
lock) length ,( S , , I---,.--.-- ­__
ubic yards
imp—
)use/ Boadift E
Bulldozing,
LZ
n,
'ne Length / /9 + /L
not sure yes
igs: not sure yes
)rium: n/a yes
yes Cl
Attached: yes
ling permit may be required by: Oe- pAt! JeV P . ea -,,VG �1 /
_s,A
❑ See note on back regarding River Basin
., � J ) _, f r l - r .// i/

Coilcnefe �K�ktie�lr
i
b
over/�
eEx, shh9 i
ku/k/, eec� f
6; y 'yjc
/O 19,x4w (� t--

US MAIL
CERTIFIED MAIL — RETUR3N RECEIPT REQUESTED
DIVISION OF COASTAL INIANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to y'} 's
(Name of Property Owner)
property located at / 0 �� � e .S�
(�96ea.A /c Cana/ a of j'Uc ch t- (Lot, Block, Road, etc.)
on fo �W 411 , in /2cealz 35-s (e Ae� C N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: y'/q _ 9 �/ % — _ Mailing Address:
He/She has described to me as shown below the development he,'she is proposing at that location,
and I have no objections to the proposal.
-----------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone].
No response is considered the same as no obieclion if you have been notified by Certified Mail
(Property Owuer Information)
Signature
Print or Type—NNa—nee
Maiiing Address -
City / State / Zip
(Riparian Property Owner Information)
Signature
Print or Type Name /
b'o p O/� t���%rSe�►�r 2 3
Flailing Addreas
City / State / 7_ip

-/777
Irv-?
4V�2,
PW?0,2
"2�2

OR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: / O / W O
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
6' �/�?,,// n6MA5
Owner's Mailing Address:
JcSO`l ;5,Ij1C1rK Q-4.
fJ LJC a-7 71 eZ
Agent's Mailing Address:
/c15--7
QC -Con y,�/e /�egc'l I%c 25'51 1
Phone Number (71q) q' q 7 Y/ I J Phone Number (�//a) i��l ` 3e 6 S—
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to Install or construct the following (activity):
14 Lek--1.01 12 s lV /la 6121
(my property located) at 11, /-Q lJo re Sf- © c 42 G n 1:� `e A44 e / /UC ,;� P l % y
This certification is valid thru (date)
4 / OS` / O
Property Owner Signature Date

licarlt:
Permit
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
iitat 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/(
temp impact
amount)
C tJ
Dredge ❑ Fill Both ❑ Other ❑
2 G-)
2
Dredge ❑ Fill Both ❑ Other ❑
G
. (J
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 ❑

PAY
To THE
ORDER OF
MARITIME BUILDERS, INC.
77 CONCORD ST.
OCEAN ISLE BEACH, NC 28469-7633
--e ' v
lank ofAmerica
ACH RiT 053000196 G�9Lb of
7 � �
FOR
II'OO 2 1 3 3n' i:0 5 3000 196i:
12-06
DATE � 0 - I _ /
2 3 7000 58 6 38 411�
DOL