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;AMA / Li DREDGE & FILL
Eli E RAL PERMIT Previous permit#
lew .Modification _'iComplete Reissue ❑Partial Reissue Date previous permit issued
.
ed by the State of North Carolina,Department of Environment and Natural Resources ,1 11� �
sstSi Resources Commission in an area of environmental concern pursuant to I 5A NCAC --� ❑Rules a ched.
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Jame t V\W r�P� t..c�k- Project Location: County 0 t35A- 0
22 H (AS w`i I—) S S. Street Address/State Road/Lot#(s)
41/ & $- StateiJL ZIP 2.....a,:(01-' cJ1--1 i-11)ilk(L.Z'►-},A. `i`i 0,y
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CW LiEW )PTA ES ❑PTS Phone# ( ) River Basin W Nit¢
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PWS: ❑FC: �, Ns...,"
� Closest Maj.Wtr. Body
as / no PNA yes.'t:.) Crit.Hab. yes / no
)roject/Activity (Le.QL r 'GI_ EK S .. .w�G ''b v.`\?'.t'o• �iQ.- t►lA T_ - c{Lai;
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distance offshore I9 a _-_ h ' —.. ` —, -`-
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not sure yes ' no -1-
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ium: n/a yes no i T. _ L
yes no - -- -RI!IP.V •------ —
Attached: yes no - i_
ng permit may be required by: IP ' �P��Z(- 6, L pL I I See note on back regarding • -r Basin n
Special Conditions 0 t-w w A L L- S 14121I. t- 11, L I.051-4X L L-- 6-6 L'Xii\ c

Arm
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Purdue,Governor James H. Gregson, Director Dee Freeman, Secretary
AGENT AUTHORIZATION FORM
DateClia/ Q D 9
l
Name of Property Owner Applying for Permit:
- -o;^,k 6 s C. ?41<
Mailing Address:
S5-1-Lt U -S -kt l- Sa
Al&tAilgovio AJC 2S_ 6, Z
I certify that I have authorized a ent Jb l-�fZl S S I D I to act on my
( g ) �4
behalf,for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) S LiP1-1 `�, E P� 1 R ' Jl" T&"-" 43o A
at(my property located at) 30 y { •
J -z-A /I) C .s?' - .4, v
This certification is valid thru (date) rq1---Lt/ 7_} D-0‹) 9
_ 0

dwtil,
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29 09 11 : 31a Joann MoDermon 610-942-4107 p. 1
CERTIFIED MAIL, - RETURN RECEIPT REQUESTED
DIVISION OF COATAI,MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO•CIFIC.ATION, 'AIVER FORM
The purpose of this form is to provide proper nonce to you as an adjacent riparian property owner to the individual or
individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a written statement has beer abtainee signed by the adjacent riparan property owners
indicating that they have no objection to the proposed work a:that the adjacent tipariar property cw-icrs have been notified
by certified mail of the proposed work. Coon these forms are submitted to the adjacent riparian property owners by a marine
contractor or other individuals acting as an authorized agent en behalf of the applicant.
This form was sent to you by the following individual or company designated by the applicant as an
authorized agent:
7'L '
Autho ' Agent'_ Signature Date/ _
Name of individual Applying For Permit: •ih�/- �/ar�
Address of Property: J /Wa/f""4 i 4 — ---
(Lot or Street Strect or Roads
/V_)/r./3" 7W7,1,4iC /1/C.
(City and County)
I hereby certify that I own property adjacent to the above-reverenced property. The individual applying for this permit
has deserted to me as shown Oil the attached drawMg the development they are proposing. A description cr d'aw
with dimensions. should he provided with this letter.
\/ I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Management. 127
Cardinal Drive Extension,Wilmington, 28405 or ca11910-796-7215 within 10 days of receipt of this notice.
No response is considered the same as no objection if 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 set back a
minimum distance of I5' 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 wish ro waive the i 5' setback requirement. '�.�
I do not wish to waive the l 5' setback requirement. , • ;
Si an Date
NCDENR
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Fs.'-+gW.vtvt.r.0 wquR,Rt Soun.CL•
(I 66, (Y1 che (1{)

''''PILINGS AND MORE 5454
V JOHN CASSIDY
PH: [phone] ss 30/
531
169 LAKE HAVEN DRIVE 531
SNEADS FERRY,NC
28460 457
hate
POYrtdoeth
r oe �u► " 1 $ V. O o
__— Dollars 8
First Citizens
Bank GP525Q3 (On. Co)
/
firstcitizens.comJ� �,
"�'
For
„):053L003001:00457L3270 „% 05454
COLONIAL CLASSII
HBrlantl Clarke

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. 0 Agent
• Print your name and address on the reverse .1►:�� 0 Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece, R.t �an�z
• ��_/ r
or on the front if space permits. 7 SE
D. Is delivery address different from item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
04=47
/v ,�ti.: gam'p
3. Service Type
iJ V2G/NC7vN ❑Certified Mail ❑Express Mail
❑Registered 0 Return Receipt for Merchandise
• /V, ( ❑ Insured Mail 0 C.O.D.
7 a/ , 4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7008 2810 0001 0492 2608
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540