54532D - May

-+LAMA / DREDGE & FILL
"EN ERAL 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 QO
fifes attached.
it Name L Project Location: County
t 7/ f Z 07, dd -P -4-,f cl P, , Street Address/ State Road/ Lot #(s) 2 ,O_� L 4t , 5
ZGw N 5111y o; ., State ZIP Z 721Y fJ/�
(Db) S- FQ — 37Y Fax # L Subdivision
zed Agent K��� Y `� s�7liR -e City Sf L i ZIP Z VY
CW [SEW C3PTA
❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
dES ❑ PTS Phone # ( ) River Basin
❑ UBA ❑ N/A
Adj. Wtr. Body / Gd tt/ (
yes k1 o_ PNA yes no, - Crit.Hab. yes / no
Closest Maj. Wtr. Body A J Ila4,1
f Project/ Activity )V P r,.J U !r' d '!9 4e L.9 7���it ih ' F , �'1 • s �u ����i Pam'
(Scale:` _
xk) length
n(s)/6 /2
mgth
ember
id/ Riprap length_
g distance offshore
ax distance offshore
hannel
ibic yards
,np
use/ Boatlift
lulldozing
ie Length
not sure yes
(fq)
ls: not sure yes
rium: n/a yes
qe,
yes
Atied: r'
yes
ing permit may be required by: /Q a,-S 14//C/e L PI-f ❑ See note on back regarding River Basin r

:RIDDLEY CABINET COMPANY INC FAX NO. :7044358123 Jun. 07 2010 01:23PM P1
07 10 1131 a Sue 910-253-7583 p.1
Df t- I. nY /qv;1)-. cons �. Page 1 of 1
31
7
r MIA,('F,Vl' Kfl'AR1A:s C(tUPL•R'TY o%N'NER STA'1'E&W.V'I'
(FOR A 11 LR 41001?bV(i Pl1, I.vGS;7g0.4 T1 IFTI)TQ4TNr)
i hereby ca:;ity that I own prop%xiy adixent to �i �_-yy--._—._.__... .`
C //�� (1anleofYrnprrt./f)wi�cr)
rrupvrty It,,ca:cd at %,0_ .l�r ... �• , ..� ]1.9_tu e.. G kin 04 l
y+ // ilxl, locL Road, etc1
C ..4+.. in . SL V.`-
(w2wrin«ly} � -Y (Town andlnr l.'rrurtty)
He has describuc! to inc, as xl:osvn below, i}.e de-veloquuer,l he is pr.11csinl: ;al Ibal Incvion, and, I f.!Iv
no ora tiuns to UN prul:•sml. I twdcrs!grl tltut n picr!rnaoring Filings ' bnudilt 1 boatlwwie musk N sal
hick a mini-vun; d.vLanee or Wleen feel (I S') from Illy muy:,:' :•ipv"ia.: access t:n(esc waivod S!y n:r-.
(if you wish to waiYk thv setback, you mnat in itiul ciao appropi lute blank brlaiv j
I do n(or wish to Naive
I do wig - tv waive tlmt setback rtduitemert.
D6,SCRkVC10V AN OF M..H1014F.l)11V.V1711)WNIENT—
(Tip he filled iN by ntdivkhal prvirosing de►etuprmur)
(lul'urmation for Property awnedAppliount (Riparian Property (Truer lik(n matlun)
Applyinl;farpermit) II
, lm'o
Wiling Mdr j
1-1 ov✓ / ` � •��l �--.
r
(:icy/Ct�for%IP ! Pant (or Type N.1mc
1 elelAvinc Number 'rulephJnc Numkw
ir�ndtU ate Ltsx

1
� a

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Jame of Property Owner: 1� --
kddress of Property:
(Lot or Street #, Street or Road,
Applicant's phone #:� (,i h �d' ��) ��— Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
has described to me as shown on the attached drawing the development they are proposing. A description of drawing.
with dimensions must be provided with this letter.
have no objections to this proposal. I have objections to this proposal.
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 Exi
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no ob'ection if vou have been notified hy Certified NIai1•
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance o
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
appropriate blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the IS' set back requirement.
(Property Ow er Informa ' n)
Signature
Print or Type Name
set►, M�, Jle fcl
Mailing Address +/
W �/
�� l dl � ✓Y11 r1 � c�v�n'M �`�( 7 1 � L_��L
(Riparian Property Owner Information)
gn ure
Print or Type Name
Mailing Address -- /

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
everly Eaves Perdue James H. Gregson
governor Director
AGENT AUTHORIZATION FORM
ite:
ime of Property Owner Applyini,
Rfor Permit:
Wing Address:
I I I;Z
JYbWXA
lone Number: �7;�,
Dee Free
SecrE
ertify that I have authorized (agent) 9 `0- 11 n � 2.n -.a V y 1h� to act on my
half, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
nstruct (activity) 7 ; ,
(my property located at) 2 d -'� /9 (: S &,j C C"n r ( %"'J-)WA, i
its certification is va ' thru (date)
�-

dicant:
V11M
Permit #: C, (JZ
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
nd 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 finz
disturbance.
Excludes any
restoration and/
temp impact
amount)
r✓ t4i
Dredge ❑ Fill ❑ Both ❑ Other
�,2
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 ❑

208536
ARS AND 00 CENTS** DATE AMOUNT
June 8, 2010 $200.00
jIgEATER THAN $10 O IRES TWO SIGNATURES
ATTE
El53611' 1:2531? L4301: LOO 10 L L6?3P
e oeuae swearoue