54557D - Ellis

AMA / DREDGE & FILL
ENERAL PERMIT Previous permit #
ew ❑Modification - Complete Reissue El 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 Aiy
C.�Roles attached.
t Name,lr,>,i✓9 L d t" T,Og � �'LL Project Location: County 6xil, S4-✓'c l`he
2 5Al
il C P / / Street Address/ State Road/57 Lot #(s) 13 )— COS
p ✓ a,� State ZIP Z 74 / 3 kNj . -S 4U)
it 2f) !/ A 16 P-9- Fax # ( )
zed Agent G✓./g, t/�ila,s%fG,,i
d ❑ CW EtM �TPTA ❑ ES- ❑ PTS
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes /� rio PNA yes / Crit.Hab. yes / no
Subdivision
City S1.vb1f, ZIP 2'7y6
Phone # ( ) River Basin
Adj. Wtr. Body /9 / /^� 1•�.
Closest Maj. Wtr. Body A/ ww
A Project/ Activity POZ, W J,- 3y LkAi 6�9 d
(Scale/ /=
ock) length
length
umber
-ad/ Riprap length
vg distance offshore_
iax distance offshore
channel
ubic yards_
imp
)use/ Boatlift
Bulldozing
ne Length
not sure
yes
, no
gs: not sure
yes
no
L.
,rium: n/a
yes
(TO
yes )
no
Attached:
ye
ro '.
0
ling permit may be required by: u ti S'C­�I% ���r 7'✓ ❑ See note on back regarding River Basin i

,ant: TGnl /� C rf ��2 E'S/� Gi L L is Permit #: 4 L S SJ
ribe 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/o
temp impact
amount)
C—
Dredge ❑ Fill„k Both ❑ Other ❑
/ Q 0
��
I G
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 ❑

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CONSTRUCTION
GENERAL
- •� ,V
age

NCDENR -
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
;hael F. Easley, Governor James H. Gregson, Director
Authorized Agent Consent Agreement
William G. Ross Jr.,
is hereby authorized to act on my be
(Printeb Name of Agent)
irder to obtain any CAMA permit(s) required for the property listed below. The authorization is limited
;cific activities described in the attached sketch.
CATION OF PROJECT:
S� in tLL�i
ZOPERTY OWNER MAILING ADDRESS:
LOA ,SAS-f' ►`�- In��, I�IE"
PHONE NO - ID - q"(P('v lepq 9
UTHORIZED AGENT MAILING ADDRESS:
► e1��rh5yfl l a"tn'-'
335" Berner �s� A �>° SVI
PHONE NO.
zi„riari mm of Property Owner: a

10:710 tf4L' gIY4Fj
CERTIFIED MAIL — RETITRN RRCEIPT RE iTl STLD
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARl' ►N PROPERTY OWNER STAT,.EtMI+.iVT
I hereby certify that I own property adjacent to > �„ �.c,�_}y �[,Sg. ELL
(,Name, of Property Owner)
property located at a . '3vu
(Lot Block, d, of %.)
on _ ,in N.C.
(W to erbody) w (Town and/or Co S
Appdcant's phone #: `f �R� Mailing Address: ��-g
He/Sho 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 PROPOSE, D DEVELOPMENT:
(Individual proposing development mast filf in description below or attach a site drawing)
Q,5�
if you have objections to what Is being proposed, you must notiry the Division of Coastal Management (DCM) in writing
within 10 days of receipt or this notice. Correspondence should be mailed to 127 Cardinal Drive Eat. Wilmington, NC
DCM representatives can also be contacted at [phone].
rJa re-iyoUse M cociidered the same as no obleerlon if you have been notified by Certified Mail
(Property Owner Information)
Signature
tLLILR4'Lr(Lur�
Print or Type Name
j� SegLE ESL Pde- SL),_
Mailing Address
SL' looL,
City / S&te / Zi
(Riparian Property Owner information)
Sign.
La f e,ac,w- A��e.��C�
Print or Type Nam*
Mailing Address
City / State / Zip

I o : 71W U fd 4b=Hj
CI:RTIFIEn MAIL - RETV1. RECEM REQUI -STED
DIVISION OF COASTAL MANAGE NW T
ADJACENT RIPARIAN PROPERTY OWNER STAT>:'EiZNT
.212
I hereby cer* that I own property adjacent to��., ,a� � �� t �-r- Pig �� � Is
(Natne of Property Owner)
property located at 135 I ,
( .,Block, Adad, ct ,.)
on T Cow , in i N.C.
(tiVaterbody) (Town and/or Cou
Appli.caaVs phone it' l2V—T Mailing Address: o20 4 � ACE
He/Sbo has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
.w..— --------- -----.-----.-------«--»---.-aw—.-------.--.-----.---.---r.--.•-w.-ww-.Poo--..---«--o-.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
-R,Ju,A L,)a
N(A� Lie 0-iff,
l.f you have objections to what Is being proposed, you must notify the Division of Coastal Manngomeut (DCM) in writing
within 10 days of receipt of this notice. Corrospondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone]:
ao,response il eots}dered the same as no oblecrlon if you have been notified by Certified1VCai1
(Property Owner Information) (Ripar' n Prop" Owner In rm 1611)
Signature Signature
Print or Type Name P,ri`nt or Type Name `
��3 � -6 e� G' e e S (.J `i D7 C'-Y'P.S!:�"t"tit,;�a\A
Mailing Address Mailing Address
City / 9tktW1 Zin t City / State / Zip

WILLIE CLARENCE RICHARDSON
DBA RICHARDSON CONSTRUCTION
PH.910-842-5596
3235 SEACREST AVE SW
SUPPLY, NC 28462-2589
Pay to the
Order of _
90/1,A7
BRANCH BANKING AND TRUST COMPANY
800
� � \ 1--B�K�BTB
&7a2 �/O Date
For
i:053 LOLL231i:00052L524892?11'045i�
4519
66-112/531
$
.Dollars � a,;�;�•°°