52434D - Sheppard

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
:]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the hate of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
}Rules attached.
nt Name roi`4i ) A�y..4 D • sff164' `2r
IU State ZIP
06) ._.4 /t�� 7 Fax#( )
zed Agent PA" Mf L t r ,c_;` ,f
X CW ❑ EW ❑ PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH C_ UBA ❑ N/A
❑ 5: ❑ FC:
yes / no PNA yes / �io Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City'AJO`%s /5 �2'!!/,,�� ZIP
Phone # (�) 3 Ze 5W�d iver Basin
Adj. Wtr. Body A1z1Vz1(-) (nat
Closest Maj. Wtr. Body��/
of Project/ Activity
(Scale:
Dck)length
-n(s)
pier(s)
ength
ember
Riprap length
tg distance offshore
iax distance offshore
j�:
:hannel 1
ibic yards_
MP -
use/ Boatlift
ie Length
not sure yes
gs: not sure yes
rium: n/a yes
yes
Attached: yes
ling permit may be required by: 0f J,S ( &-e4j (' 0 I� El See note on back
1 regarding River Basin
Basin r
I- .- .... AY / ..".•la T.... ,- - z!;-7t IJAA L��Il Q6'DI Y, //A Z!

A��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Ji
Authorized Agent Consent Agreement
is hereby authorized to act on my t
i order to obtain any CAMA permit(s) required for the property listed below. The authorization is limite
pecific activities described in the attached sketch.
OCATION OF PROJECT:
'R`OPERTY OWNER MAILING ADDRESS: Q
PHONE NO.
kUTHORIZED AGENT MAILING ADDRESS:
HONE N
Signature of Property Owner:

FAX NO. :
Jan. 04 2010 11:12AM P
_ ott1 iouse Marine Construction, Inc,
'03t Ofte Box 2532
i(Nf MY, NC 28M
910) 328.4852
S-�6'-'>4-V� 9
C pu erefj fl'Z� u
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1` :• FAX NO. : Jan. 04 2010 10:57AM P1
Name Of
wA
Indi idual A.0ID
` yin for
--�
1i
pGy -� V
r
►1YNp \'
add_ es s
C ot
r
(Lot oz St,t 5t��b` Raad
county)
I hereby cer-i:Ey that I awe
referenced Dr�rty. 'r'he Town rox�rty adjacent to the above
dascrioea individual azi�lY=ng nor this
�o m� as shown a*t the attached Pe�nit has
they a`? '_7�w"�3QS?�Tl dzawA ng the deve� 0 4
shatld be -Provided with th ss letter or drawing, with d2mensior�s,
I
have SIO aecti0ilS %_ 1-h1S ]=ODOEc1.
r
� P
*y �• ? p
' Y
T =darst.L°n.R tbow 8 p;Lp-r,, Clock, :�a7' OS tGJ
==e o= -DOE- 17:Lf-t 7=- be silt .bad z ,��:� �=st3t�e ❑� :a' �'�am
my asva Of =pa= a.sn dccass - utless wa *ivfld 'y .. (2:- YouvMiwish tc
't►e :he .s t:s+zech, You must anropriate a? a im buloa•. )
I gib v;i =
Si! Sa �KaC71:' rnT[taT3 _
= do 23n:L wish td wa..V_Z� one 1� se:4back -e=izamsnt_
a
Sign IC'ama 1,R72

FAX NO. :
Jan. 04 2010 10:57AM P1,,
U
Dame 0 indi App ;- y
ideal iyina for p_M,-
Address C= prdpez
(Lot oz St_t Str�st Road,
hereby c ify ;,hat I
awu-
referenced rot�rtY adjacent to the
�t'o�rtY- The individual applyzn abDv?
described to me as shown on g _o. th's perMit has
La1B axe r the st:.ached drawl t9 the aeve7 otymen4
Y e.p_auasing. A description with d2mensi
ion or drawinq, or�s,
sho + be Provided with .th.- s le'"
I have to objections 40 thi pr onasai .
_ o
� r �
r � .
I understand tkL--- a pies, dock, :moa.bzsi�g pilings, '�rea's:�oa*e=, i�ozet
=e or bom- '? l:!t must be sat .ba Z m-'. ►t c istance o-
s arm Of pa.: iam acadss - ualess wa=.ved 2DY -Jrte.. (M-P You wish to
vai't►a the .sa acJr., You muat :.xz_tia7 t3L apPrOPriats blank, below*. }
1 L1C1 Yiibli �O 4v2lve Mil$ zeCiij' r9m--nl- "
$Q --nnr wzsh to wa : Ve the IS I Setback equi-rement._

4001
66-19/530 NC
702
$44,00 00,
JOHNNIE D. SHEPPARD 11-09
252-559-9666
P.O. BOX 2891
SURF CITY, NC 28445-0047 /� 1
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_ -- -- DDollarsarsBankofAmerica
ACH /T 053000196 V P 5434(0),
Memo
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