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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue ,lames H. Gregson Dee Frei
Governor Director Seci
AGENT AUTHORIZATION FORM
Date: /U ,P-- 20/ZI
Jame of Property owner Applying for Permit: Name of Authorized Agent for this project:
)wner's Mailing Address:
?hone Number (q10) .S'?f '
Agent's /Mailing Address:
�'-�V v / - � ✓�IIV^r �f I
Phone Number(`/y) 5-9`�'r'Z1��.
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):
P,�-,,L
(my property located) at
This certific on is valid t ( te)
Jy�.r-_2v�o

'omplete Items 1, 2, and 3. Also complete
tem 4 if Restricted Delivery is desired.
Irint your name and address on the reverse
;o that we can return the card to you.
\ttach this card to the back of the mailpiece
>r on the front if space permits.
vticle Addressed to: /
)O v g IRs 5t79 MM 14 N11) �Z
A. sl9�re, l
A. { Agent
❑ Addressee
j7c ed by (Printed me) C. Date of Delivery
D. Is delivery address different from item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
% e

)F WAy
FT.
�S
Calabash River``
b Uer—
IWT
WOOd Bulkhecd
REBAR SET
MESS CORNER
I N
N
34077.0 SQ. FT.
0.78 ACRES
William A. Davis
- o DB 1121, PG. 510
o MC W, PC. 23
WIRE FENCE ALONG - -
0-=. "",PROPERTY LINE
Z
J � N
S 00'06'47" W
a g 28.28' Ip FE)
AREA SUMhWy: ? / s
LOTS: 14, 15, 15A, k 14A (�4
/ iP FD.,
TOTAL AREA LINE ITO BE ABANDONED UPON ��i �i�♦
0.86 ACRES RECO � gTION OF THIS MAP S'
BY Coordinates ,/ s
1 - v Asj \
1•
IP,
LINE TO BE ABANDONED UPON
RECORDATION OF THIS MAP
O
IP Fp o iP FDV
REBAR SET U' Bynum D. Sharp, Sr.
D 7.0.00' FD DB 1061, PC. 154 S`
rn �
N S 81•:�FJ OQ w ��.D �ti•
0 REBAR SET oD9\
0 70.Ot1 '30, 6`
REBAR SET N N a 1 45 00 E Ch. P FD.

N
fv
w�
0
ml

Division of Coastal Mgt. Habitat Impact Computer Sheet
licant: e L 60ZIta le Permit #: 13 / S 31
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in vour Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
�itat Name
Choose One
anticipated
restoration
any anticipated
restoration and/c
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount)
L
Dredge ❑ Fill Both ❑ Other ❑
00
`
Dredge ❑ Fill ❑ Both ❑ Other ❑
2 / FO
2
j
Dredge ❑ Fill Both ❑ Other ❑
9
<^
Dredge ❑ Fill ❑ Both ❑ Other
r
�/
■ 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:
U W I f� •(JO �tJ L
?I 3e3
2. Article Number
(Transfer from service label)
PS Form 3811, February 2004
A.
C.
❑ Agent
D. Is delivery addrdss different from item 1? LJ Yes
if YES, enter delivery address below: ❑ No
i'3 y 11 - X 19
3. Type
9Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7009 1680 0002 3801 5231
Domestic Return Receipt
Dredge ❑ Fill 0 Both ❑ Other ❑
102595-02-M-1540

CALABASH AUTO PARTS, INC.
1001 BEACH DR SW
SUNSET BEACH, NC 28468-4839
[phone]
PAY TO THE
ORDER OF�(O /J
MEMO
1150000 2 29 111'
FIRST BANK
OCEAN ISLE BEACH, NORTH CAROLINA 28469
66-456-531
l:053 1045681: 79100 L LOgll■
r
AUTHORIZED SIGNATIll