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Attached: yes
ing permit may be required by: lye& / 4 Yy/ ❑ See note on back regarding River Basin n

FROM Jimmy North - CMC FAX NO. 9102566357 Jul. 15 202 Bi:46PM P2
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HIC
North Carolina Department of Environment and Natural Resources
Division of Coastal Management.
everiy Eaves Perdue James H. Gregson Dee Enema
;overnor
Director Secreta
AGENT AUTHORIZATION FORM
Date: � / 0
ame of Property Owner Applying for Permit:
e-1 Su 0J 4 o CO
owner's Mailing Address:
.�
)hone Number (�5d)- D
Name off -*Authorized Agent for this project;
Agent's ,Mailing Addresss:
Phone Number ( Q102 L- E-5 Z. V .__
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at 8 S/2
This certification is valid thru (date)
Rr� �Al ? - Ig - t
Property Owner Signature Date

L� LLB kc f tit-
:a) A�i=\ i i�P.Ai`..�'�'UV.^tIriz \1U"i'IFiCAT10N,ti�'.AV'�R FORA
Name of Individual Applying For Permit:
Address of Property: � 5 a 1 � c (r-J 'Cs /E L 4 =`' f
(Lot or Street a, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -referenced property, The indivi
applying forthkis permit has described to me as shown on the afta.ched drawing the development
on or drawing, with dimensions, should be provided 1,vith this lette
are proposing. A descri
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Co,
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-'
within 10 days of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must 1
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (I
wish to waive the setback, you must initial the apAra riate blank below.}
I do wish to waive the 151 setback requirement.
I do not wish to waive the 1 S' setback requirement.
!e
A11101CWA

FROM Jimmy North , f1O FAX NO. 9102566357 Jul. 15 2010 01:46PM P1
4 )JOki A.ti:A\ n; __s''_�,� 1 t_1�1i�;"t(.lt \C� � r1TiC,'1V.�:� -tip
Address of Property:
(I.oc or 5crcet 4, Stre.t or Road)
(City and
I hereby cenify thaT I owr: popery adjacent to the ttbove•refereuaed prupzty� The individual
applyiag far this permit has described to Me 95 shown M the eftached drawing the developme:�c t>�}.
are proposing• A description or drawing; with dime,,LAona, shoald be provided with this letter.
I have no objections to this proposal,
If you have objecdoas to what is sating proposed{ place write thr DINIAOa of Coastal
Mauagemtat, 127 Cardinal Drive E.xtonsion, WtloatVoA, NC 26405 or call 910-796-7215
witb;n 10 days of receipt of this notice. No response to considered the same ano objection, if
you have been notified by Certitled Malt.
NVAIVRR SECTION
r understand that a pier, dock, mooritsl pilings; broakwatex, boat house or boat HA must ba set
bek a rainimum distance of 15` from MY area of riparian access - unless waived by me, (If You
wish to waive the setback, your muss initial t e aApro'Erlate blank 1aw.)
i do %,10 to tiVaivo ;he 15' sethack requirsmettt.
I Mgt wish to waive the 15' 10tback rec uiremant-
r
7/�
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Hnt Name
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �e 71 tA-P-o S Permit
Date: /1�' l
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
found in your Habitat code sheet.
Habitat 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 fi
disturbance.
Excludes any
restoration an
temp impact
amount)
Dredge ❑ Fill j�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 ❑
Dredge ❑ Fill ❑ Both ❑ Other 171

COASTAL MARINE PIERS & BULKHEADS LLC
NCDL 3831595
6314 WRIGHTSVILLE AVE 910-256-6357
WILMINGTON, NC 28403
DATE
TO THE
ORDER OF
WACHOVIA
Wachovia Bank, N.A.
wachovia.com '' i-1'�
FOR 40rx3 (- rJa(cw (no)
1160 i 7 i8 SO 1:0 5 3000 2 i 9i: 208 6 i
nc