54439D - Maxwell

CAMA / DREDGE & FILL '
GENERAL PERMIT Previous permit#
_,New 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
Cl�Rvbes attached.
it Name l /ZJ ,Ast e. 10 Project Location: County Ta ,'-S 'v , c Ae
Street Address/ State Road/ Lot #(s)
",/gl�o, State ZIP
(- j ) A2 _ cr ''F//ax # ( ) Subdivision
:dAgent ✓y�RNun City/®l4/0..� ��AGh ZIP
,d CW EW PTA
QES ❑ PTS
Phone # ( )
Basin LV ,-r
OEA HHF = IH
❑ UBA �] N/A
Adj. Wtr. Body CO, NA
(River
� c/l � w W(nat
PWS: ❑FC:
��� ✓
yes / no PNA yes no
Crit.Hab. yes / no
Closest Maj. Wtr. Body
of Project/ Activity Net-..,
/- L G A 1� ..� s �u C
�� / G
(Scale:
lock) length Cx
length
lumber
!ad/ Riprap length
tvg distance offshore
nax distance offshore
channel
:ubic yards
amp )use/ "dift X ,
Bulldozing
- Tielol-2D 17
ine Length S L%
not sure yes no
igs: not sure yes no
)rium: n/a yes no
yes r567i
Attached: yes no_,,
ling permit may be required by: /(/ 6 C/'O L /1 ❑ See note on back regarding River Basin
/ C���:�1 P'��J7a.��� �J. , • / -f." n 7- /3. i 'f X

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el F. Easley, Governor
NAA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Charles S. Jones, Director
Authorized Agent Consent Agreement
4rpc1- /VN
William G. Ross Jr.,
is hereby authorized to act on my bi
(Printed Name of Agent)
:r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited
c activities described in the attached sketch.
TION OF PROJECT:
Onc
=RTY OWNER MAILING ADDRESS:
l� YP u�
)RIZED AGENT MAILING ADDRESS:
X Z2. c
PHONE NO. Y16)—
P H 0 N E N0.ald-�'J741 - 77/U

C Division of Coastal Mgt. Habitat impact Computer Sheet
)plicant:, C. • De4 1 ,,14_5 /`20jc 1-✓9- L
ate:
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
fund in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fine
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
abitat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excludes any
restoration and)
restoration or
and/or temp
restoration or
temp impact
temD impacts)
impact amount)
temp impacts
amount
o � I Dredge ❑ Fill ❑ Both ❑ Other" I / � G 1 4 011
■ Complete items 1, 2, ana 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:
A. ature
X
nt
Addressee
eIv y (Printed e)
ateRRf Pelivery
(�G�'��
D. Is delivery address different from item 1?
If YES,
y❑Yes
No
enter delivery address below:
rol
3. Service Type
Fa'Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
1 2. Article Number 7009 1680 0000 3950 1162
(rransfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
I Ure
Drec • Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
Drec 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.
Dre(
1. Article Addressed to:
jo�.rr-�eS �►.M'e.rr\ 1�
W
rved bynn Name) C. Date of Delivery
'-".3 -, CA,( 2 / 1 /Z C'/ � -
Is delivery address different from item 1? YY s
If YES, enter delivery address below: u No

TRACY D VARNUM
NCDL 8695114 910-846-7710
3295 STONE CHIMNEY RD SW
SUPPLY, NO 28462-5933
Pay to the G <
Order of
rj 16 Date
5104
66-121b/531
m
�7.
WACCAMAW
BANK
sum cxto28462
an ze b
www.waccamawunk.cum
6 G
For
is0 5 3 112 IS 21:8000 6 7 588011-0 5 10 L. r- — C33M,. EM