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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
el F. Easley, Govemor James H. Gregson, Director
Authorized Agent Consent Agreement
C
William G. Ross Jr., Secr
is hereby authorized to act on my behal
(Printed Name of Agent)
:r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to t
is activities described in the attached sketch.
►TION OF PROJECT:
72
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)ERTY OWNE,R� MAILI7:,DRESS:
..j , /'? "V
4, 0r 0 A, 727,C
-IORIZED AGENT MAILING ADDRESS:
1 �
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pill'� l
PHONE NO.U�
S T PHONE NO. 2 / o 6R 6,- --Z '5S
nti ira of PrnnPrty Owner. //C/

Map Uutput
Fage 1 of
New Hanover Co., NC
40
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Qa014-mWP
.8 *Y-71
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: -ramoi
Address of Property: 179 �eo c, RA. (�"'A
(Lot or Street #, Street or Road)
C, 2811(
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tl
are proposing. A description or drawing, with dimensions, should be provided with this letter.
Dje�,,�c3 oN l y .
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-72
within 10 days of receipt of this notice. No response is considered the same as no objectior.
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yl
wish to waive the setback, you must initial the appropriate blank below.)
Sign Name
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 1 5' setback requirement.
10-1-,
Date
to
EJ'ec'), ll�'a nrl�.!s 0=> n
Print Name AT,

Coastal Earthworks, Inc.
1955 Middle Sound loop Road I Wilmington, NC 28405 • Phone; [phone] - Fox (910) 8
F�h-Y S
Mr,* Mrs Esc.r
20°8 ( Fr-���� pd.
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Da,- lNs: K74e1-)
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porm�� O'A er� G�&-4err'f Art�je prr6 +' PNe +'C3 P(c%c
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C Division of Coastal Mgt. Habitat Impact Computer Sheet
plicant: "
te:
!l �2 Aw
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat 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 fina
disturbance.
Excludes any
restoration andh
temp impact
amount)
Dredge Fill ❑ Both ❑ Other ❑
©D
rLJ
Dredge ❑ Fill Both ❑ Other El
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 ❑

COASTAL EARTH WORKS INC. 3750
[phone]
1955 MIDDLE SOUND LOOP ROAD 66-7t72/253t
WILMINGTON, NC 28411
1)-2-10
Date
Pay to the A 1
Order of ,, ``� �p 1 V J $ 4 0 0 . D6
C-s [milUrf�r—C A 4r 4 ' 0 Dollars
COOPERATIVE
BANK
WILMINGTON, NC
Fltr J��F�
1: 2 5 3 1 7 1 7 281: L 6 900 10 30 21
8 Dc e�li�on
Beck.
.—�.�._.r_
sv
I' 0 3 5 0

2. Article Number
(Transfer from service label)
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
e Print your name'and address on the reverse
so tharwe 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:
90lves+ + F". e
5 211� Co k we O d 4c,
9a1e�51.1 A;,G. 27EoI
(Traj
PS Foi
IN Complete items 1, 2, and 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:
Ml C-cc bes►Md--O'jc�
I Oo A v, c Y► c"A )
CAJ-y I N t C , 2'?S( )
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7010 0780 0001 6935 1369
A. Sig ture
X I n El Agent
- 1 ❑ Addressee
B. Received by (Printed Name) I C$Aate oYDglivery
D. Is delivery address different from iterr%1
If YES, enter delivery address below:
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
102595-02-M-1540
A. Signa>ure
❑ Agent
❑ Addressee
B<Receiveo by (Printed ye) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No