56502D - Gibson

CAMA / 1 DREDGE & FILL
IEN E RAL 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 ^j
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC //7 • Q
�R"Tu es attached.
t Name /, D r✓ 6�, Project Location: County & ti i <-��
3 y _57' Street Address/ State Road/ Lot #(s) -2
L'0 t State G ZIP 2- V J
_ Fax # (_
ized Agent
d CW DEW PTA
❑ OEA ❑ HHF IH
❑ PWS: i FC:
yes no PNA yes / no
-'ES
- UBA
PTS
❑ N/A
Crit.Hab. yes / no
Subdivision
City C'5 "A r ­55 L. f- 01194 ZIP
Phone # ( ) River Basin L vi
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ding permit may be required by: Cc PA.✓ _-r5-1.p 13,9,9 `i ] See note on back regarding River Basin

3/2010 13:33 FAX .10
t F r
:hael F. Easley, Governor
462 4425
GIBSON OIL & GAS COMPANY
910-237-4332
AWA
NCDENR
North Carolina Department of Environment and Natural Resoi.imes
Division of Coastal Management
Charfes S. Jonas, pirector
Authorized Agent Consent Agreement;
Z001
p.1
V11111am G. Ross Jr., Secrela
(Pr."n1m0 Ntm7e O(Agent)
is hereby autF,orized to act on my behalf
der to obtain any CAMtA permit(s) required for the property fisted below. the authorization is limited to the
iflc activities described in the attached sketch.
ATION OF PROJECT:
'FRTY OWNER MAILING ADDRESS:
j
PHONE NO._ '�Q --:: SD --S / 13 0Gf'
ORIZi=-D AGENT MAILING ADDRESS:
PHONE NO.
ire of Property Owner
re of Authorized Agenl
Date? /V�(/. �5 , 2A lO

'0+
Y
•
-1'T-4VA. -�
iA

1 10 01:53a 3362755825
3362755825 p.1
7 I V-LO l-4JJL p.1
DTVI-SION OF OASTAL INIANAMMENT
ADJACENT RIPARIAN ROPERTYOWNiER STATEMENT
I hereby certify that I own property adjace to C) �l �/ S d n 's
�� �� �r S (Narne of Property O.vner)
property located at _
on �sd , in
(VYaterbody)
Applicant's phone 9:
Be/She has described tz) me as shown below the de%
and I have no objections to the proposal.
DESCRIPTION ANDIOR DRA
(Individual proposing develo ment mi
if yo■ have objections to what is being proposed, you
within 10 days of receipt of this notice. Corresponrlea
DCNI representatives can also be contacted at (910) 1
(Property Owner Information)
Print or Type Narne
Mailing Address
City IState IZip
Telephone Number
Date
t, B]ocl(,Road, etc.)
N,C.
(Town andlor County)
Mailing Address: `
en[ nwsne m proposing at that location,
PING OF PROPOSED DEVELOPiviENT`
.(fat in descriptiojr below or attach a site drawing)
r , 1�
Yc. e i tti C Aa A OL CPS r t n
o V e- C4 m� e� t:� e a cl
— „v,,._ --- --, o, ---al tvtRrtab cent (ui m) in t raing
should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
•7215,
Wertion if You have been notified By ('n tinnri Ivan
(Ri rian Property O►voer Information)
Signahtre � J p
i s
Print or Type Narne
Mailing Address
City / State / Zip
Telephone Number
D a-e

l6/2010 20:05 FAX [phone] GIBSON OIL & GAS COMPANY
US MAIL.
4 001
CERTIFIED MAIL - RETURN RECELET REMUS—TER
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATE?AENT
r � is
herebycertifythat I own property adjacent to o d ` ��
I Propexty Owner)
property located at ^t r �
\ ' (Lot, Block, ad, etc.) N.C.
on -� — in
(Water od� (Town and/or County)
Applicant's phone #: 18 � O Mailing Address:
,l-le/She has described to me as shown below the development he/she is proposing at tha 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 at'acha site drawing)
F-f—fx oar � � W j2 t K, 14-trc n
r4 Y% eU elti+. R e. wt o o e— w a ske �o O
rC-
If you have objectiolu to what is being proposed, you must notify the Division of Coastal h,ianagement (DCM) in writing
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardiva!, Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone],
o res onse is considered t e same w no b'rclio if ou hove been notified by Certified Mall
4(Pr perty Owner Information, —
la S �n
Sign e
Print'or Type Name
q3
Mailing Address
d/11IG 2 g 3 s
City / State / Zip q /22
3
k
(Riparian Property owner Information)
Signature
Print or Type Name
Mailing Address
City / State / Zip
Telephone Number

DiVIS21of Cori ter,; &Iqt:,
icant: k d
1 / A// d
Permit #: L - 6) -e2 --P
tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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/c
temp impact
amount)
j
Dredge Fill [IBoth ElOther ❑
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 ❑

-_ ­14i
GLEN N. WILLIAMSON 66-7143-2531
NCDL 4918602 1556
PO BOX 1602
SHALLOT7E, NC 26459 DATE 11—
PH. [phone]
PAY TO THE
c ORDER OF f N' s
SEcuRrry
SAviNcs BANK
Sha - llott - e, NC 284j9
MEMO...
1: 2 S 3 17 11., 300000 h 14 19 7116 IS 56
_4