56518D - Prestage

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �'� ^ rl'� %` s
(Name of Propierty Owner)
property located at 7
(Lot, Block, Road, etc.)
on in 1rf ...,. N.C.
(Waterbody) (Town and/or County)
0.
Applicant's phone # G'' ' ` �' " Mailing Address: -Zoe
He has described to me, as shown below, the development he is -proposing at that location, and, I
have no objections to his proposal. io
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
1 a � •
04-
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
-
-�Or3cS Arrow,�-
Mailing Address �^ Signature
i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I herebycertify that I own property adjacent to n � 4c5, e 's
fY -
(Name of Prooky Owner)
property located at,? kr � � � �h t'-, � ,
(Lot, Block, Road, etc.)
on l �' �s , a;�,-'- `� , in T� , N.C.
(Waterbody) (TOWI and/or County)
Applicant's phone hone #t910)f72 - y& 14 Mailing Address: Z©�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------------------------------------------------------------------------
f I DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
I�
ilk
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
s
Signature
%/lmbn. Nfc." 7932k

A'r
6jf�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverty Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date IG 1� 2D/b
Name�of Pro rty[Owner Applying for Permit:
�� YI TCSI q c,
Mailing Address:
C/1' f�� , Al G Z'F3 z�
I certify that I have authorized (agent) 94 !E 171-H nL Gn s/rW / 01 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
11.4
/install or construct (activity) A2 f / c!G
at (my property located at) 7 � Z 3 S�'ugj SL f L
This certification is valid thru (date)
S�(-PC;/V ,NL
16/1srize / v
Owner Signature

Division of Coastal Pi Habitat Impact Computer Sheet
ilican& � - Permit #:
e:
1Z11/1 0
;cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
kat 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/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
C�D
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 ❑
l„ x91C) = �W

B AND B MARINE CONSTRUCTION
1168 COREY DRIVE
WILLIAMSTON, NC 27892
PAY
TO THE
ORDER OF.
1049
66-21 /530
1 l
DATE // BRANCH 77839
' /l � f �" /BRANCH
i $ i 00- 00
DOLLARS
® WACHOVIA
We^lw Is Bank, a dvielon of Wells Fargo Be*. N.A.
FOR GP �(oJ`rlg D—Yk—( be .
11000 L04911, 1:053000 2 L91: 20000 448 001,.