54591D - Parker

CAMA / DREDGE & FILL 54
;EN ERAL PERMIT Previous permit #
Date previous permit issued
ew Modification ❑Complete Reissu6 ❑Partial Reissue
•ized by the State of North Carolina, Department of Environment and Natural Resources �� 1 �Od
:oastal Resources Cbmmission in an area of environmental concern pursuant to 15A NCAC
ules attached.
t Namej;V J , i2 ��t'Lt�C
c #I DC State IV C- zlP 3j S
Fax#()
:ed Agent as f' rp 9 S
Cw S.EW Ey"A �7+ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
yes PNA yes
f Project/ Activity P
>ck) length
)ier(s)
.ngth
ember
id/ Riprap length
,g distance offshore
_�.4_
ax distance offshore _._...__
:hannel
ibic yards
mp
use/ BoAtbfts.-
3ulldozing
Pfs 6ZJJ� /?1t � I
ne LengthQ
not sure yes
cgs: not sure yes
>rium: n/a yes
�e no
Attached: yes
Crit.Hab. yes / no
Project Location: County -0 .1/14.1/C,c
Street Address/ State Road/ Lot #(s) f
Subdivision
City�c� p.� v 9C _ ZIP Z
Phone # () River Basin
Adj. Wtr. Body C. f%N L /4/ �✓ (na-�
Closest Maj. Wtr. Body 'el w
Ol
(Scale
�6
ling permit may be required by: /A zd'O'' See note on back regarding River Basin i

T nKKm K-
1 V
[---1 6'-1
Wood
deck
Al. Dock,
Ramp
Z v / -
100'
r-

AMWA
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
.ayes Perdue James H. Gregson
r Director
AGENT AUTHORIZATION FORM
-7 11(0is
Property Owner App1 in for Permit:
i
Address:
A&r'aekyJ r,� c d0i s
iumber: ab t bA s' 6S 13 ----- - -
Dee Freeman
Secretary
that I have authorized (agent) to act on my
or the purpose of applying for and obtaining all CAMA Permits necessary to install or
K (activity)
,roperty located at)
icati is valiAt
u (date)
V-- d— VWX
Z,
4C-1

A b L4.4 V 'YL-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLLFTBOATHOUSE)
I hereby certify that I own property adjacent to _ �� is
(Name of Property Uwner)
property located at
(Lot, Bfock, Road, etc.)
on
��!7�C / , in 6�J N.C.
(Waterbody) (Town and/or County)
Applicant's phone �]-Zb�Sailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I S) 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 not wish to waive
I do wish to waive that setback requirement.
-- ------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-------------------------------------
--
(Information for Property Owner Applying (Ripar'a I
for Permit)
Mailing Address
----------------------------------
r v Owner "rmation) ,
J i�'jllca441 v
Aoocr�2

08/03/2010 11:54 9107555022 _'UPPLV PO
be: i very Record:
PAGE 01
Page I of 1
92, CiNITED ST11TES
Date: 08/03/2010
Dear Postal Customer:
The following is in response to your 08/03/2010 request for delivery information on your
Certified Mail(TM) item number 7010 0780 0002 0184 0769. The delivery record shows that
this item was delivered on 0711912010 at 4:32 pm in HOBBS, NM 88240. The scanned image
of the recipient informatlon is provided below.
Signature of Recipient:"'�!w+�-Y
thaw" MOCUM
I
Address of Recipient: —..__... _
Thank you for selecting the Postal Service for your mailing needs. If you require additional
assistance, please contact your local Past Office or postal representative.
Sincerely,
United States Postal Service

icant: �5-,9rq ej �eaK Pti Permit #:
: 011 L9
tribe 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/c
temp impact
amount)
lam"
Dredge ❑ Fill ❑ Both ❑ Other
3 5 6
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 ❑

ENERGY AND CONTROL LLC 1 020
PH. 704-813-5800
372 OCEAN BLVD. W. 66-112/531
SUPPLY, NC 28462 O
DATE
PAY TO THE
ORDER OF-_-i _ 00-
DOLLARS '
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.com C
FOR - - - F�-+-
--- IVP
I.053 10112 11:0005 100 23 274 1