SC_11-18_ Burge

Issued by WiRO Sc 11-18
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina,Department of Environment,
and Natural Resources and the Coastal Resources Commission for development
in an area of environment concern pursuant to Section 113A-118 of the
General Statutes,"Coastal Area Management"
Issued to Glenn and Barbara Burge, authorizing development in the Estuarine Shoreline (AEC) at 6029 6th Street, in
Surf City, Onslow County as requested in the permittee's application, dated October 3, 2011, and received by DCM on
October 4, 2011. This permit, issued on December 5, 2011, is subject to compliance with the application and site
drawing (where consistent with the permit), all applicable regulations and special conditions and notes set forth below.
Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be
null and void.
This permit authorizes: Installation of a 10'x 28'flat roof over an existing deck and concrete drivway.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s)dated received on October 4, 2011 and revised on November 15,2011.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. From the date of an appeal, any
work conducted under this permit must cease until the appeal is resolved. This
permit must be on the project site and accessible to the permit officer when the
project is inspected for compliance. Any maintenance work or project Jason Dail
modification not covered under this permit, require further written permit CAMA LOCAL PERMIT OFFICIAL
approval.All work must cease when this permit expires on:
127 Cardinal Drive Extension
January 26,2015 Wilmington, NC 28405-3845
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal PERMITTEE
Management. (Signature required if conditions above apply to permit)

Name: Glenn and Barbara Burge
Minor Permit#SC11-18
Date: December 5, 2011
Page 2
(5) The amount of impervious surface shall not exceed 30% of the lot area within 75 feet of the Normal High Water
(Estuarine Shoreline Area of Environmental Concern), in this case, 25 square feet is authorized.
(6) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of Normal High Water level. In this case,
the proposed 10'x 28' roof is the only structure authorized within 30'of Normal High Water.
(7) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land-disturbing activities, a barrier line of filter cloth must
be installed between the land disturbing activity and the adjacent marsh or water areas, until such time as the area
has been properly stabilized with a vegetative cover.
(8) Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent waterbody. This area shall be immediately vegetatively stabilized, and
must remain in a vegetated state.
SIGNATURE: DATE:
PERMITTEE

Locality 3uIc /7'y! Permit Number 3C //`/X
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only)
GENERAL INFORMATION
LAND OWNER
Name GfeitiYZ Xlam•(& but 13 ei
Address 57 59 DO ✓e- be.
City Ply 0([IS State PC' Zip 2 8 3't8 Phone q/©-• Z 5?S 7'
AUTHORIZED AGENT Name L3f5 c 121.47(If
ec
Address (o O 33 fit• -
To /
City St t o r P State/ L Zip -�j t7`}5 Phone C/0-S3 '7735—
LOCATION OF PROJECT: (Address,street name and/or directions to site. If not oceanfro t,what is the name of
the adjacent waterbody?) cpO 24 She- 1, S,v)-0 C,, Mc._ 28 y-s
DESCRIPTION OF PROJECT: (List all proposed construction and land distu bance.) Tc W�S h �(
i o' x 2�' -G tit roof o J� its d ecg
SIZE OF LOT/PARCEL: 1' 144 2, square feet . la acres
PROPOSED USE: Residential ✓ (Single-family Multi-family ) Commerical/Industrial
Dther
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF ENVI-
RONMENTAL CONCERN (AEC): square feet (includes all floors and roof-covered decks)
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT-UPON SURFACES IN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): sq. ft.
Calculations include the area of the roof/drip line of all buildings, driveways, covered decks, concrete or masonry patios,
:tc. that are within the applicable AEC.Attach your calculations with the project drawing.)
Choose the AEC area that applies to your property:
:1) within 75 feet of Normal High Water for the Estuarine Shoreline AEC
:2) within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding
Zesource Waters •
;3) within 30 feet of the Public Trust Shoreline AEC
Contact your Local Permit Officer if you are not sure which AEC applies to your property.) R EC E IV ED M
;TATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to aINGTON,NC
hate Stormwater Management Permit issued by the N.C. Division of Water Quality? O C T 0 4 2011
(ES NO
f yes,list the total built-upon area/impervious surface allowed for your lot or parcel. square feet.

if zr
, ,
OAST41 44%
. APPLICATION FOR
,.
cl
......
CAMAMINOR
.... 2
.., DEVELOPMENT
> ,.,.....,
PERMIT
se.
In 1974, the North Carolina General Assembly passed the Coastal Area
Management Act and set the stage for guiding development in fragile
.. and productive areas that border the state's sounds and oceanfront. Along
with requiring special care by those who build and develop, the General
Assembly directed the Coastal Resources Commission (CRC) to imple- ,
ment clear regulations that minimize the burden on the applicant.
This application for a minor development permit under CAMA is part
* of the Commission's effort to meet the spirit and intent of the General
Assembly. It has been designed to be straightforward and require no
,i
z more time or effort necessary from the applicant. Please go over this
i
folder with the Local Permit Officer(LPO) for the locality in which you
plan to build to be certain that you understand whatinformation he or
she needs.
i # # Under CAMA regulations, the minor permit is to be issued within 25
days once a complete application is in hand. Often less time is needed if
the project is simple. The process generally takes about 18 days. You
III' can speed the approval process by making certain that your application
"`- , Ai' itti is complete and signed,that your drawing meets the specifications given
1 inside and that your application fee is attached.
.,,„41 4, r
Other permits are sometimes required for development in the coastal
V r 1 area. While these are not CAMA-related,we urge you to check with the
Local Permit Officer to determine which of these you may need. A
4 lis ' is included on page 2 of this folder.
, . _ `
g �'We appreciate your cooperation with the North Ca
rolina Coastal h Man-
agement Program and your willingness to build in a way that protects
',-
the resources of our beautiful and productive coast.
Coastal Resources Commission
RECEIVED Division of Coastal Management
C.-,M WILMINGTON. NC
OCT 042011
All

OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA minor
development permit.As a service we have compiled a list of the kinds of permits that might be required.We suggest you check over the list
with your LPO to determine if any of these apply to your project:Zoning,Drinking Water Well,Septic Tank(or other sanitary waste
treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation,FIA Certification,
Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway,Connection,and others.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein.This interest can be
described as: (check one)
an owner or record title.Title is vested in , see Deed Book 6a q 3
page 8( ( in the C>v,s%OW County Registry of Deeds.
an owner by virtue of inheritance.Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contract or lease, explain below or use a separate sheet and attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name 1 (Address)
(1) � �C. c S Ce.. ° 2 7 (+.-Si-.
(2) ��I-fin t� Led,Pe. 4o 3 I 5 SA-
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I acknowledge that the land owner is aware that the proposed development is planned for an area which may be susceptible to
erosion and/or flooding. I acknowledge that the local permit officer has explained to me the particular hazard problems associ-
ated with this lot.This explanation was accompanied by recommendations concerni ►0 EiCaE1iMiEirU foodproofing tech-
niques. DCM WILMINGTON, NC
PERMISSION TO ENTER ON LAND: O C T 0 4 2011
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer and his agents to
enter on the aforementioned lands in connection with evaluating information related to this permit application.
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality, and any infor-
mation as may be provided orally by the applicant.The details of the application as described by these sources are incorporated
without reference in any permit which may be issued. Deviation from these details will constitute a violation of any permit.Any
person developing in an AEC without permit is subject to civil, criminal and administrative action.
This th day of ��` `' 20 //
Leis I40D0*,,_ Ce--
64
Landowner or person auth • act as his agent for purpose of filing a CAMA permit application.

SITE DRAWING/APPLICATION CHECKLIST
ase make sure your site drawing includes the following information required for a CAMA minor development
.mit.The drawing may be simple and not necessarily to scale.The Local Permit Officer will help you, if
uested.
[YSICAL DIMENSIONS
Label roads
Label highways right-of-ways
Label local setbac:{lines
Label any and all structures and driveways currently existing on property
[YSICAL CHARACTERISTICS
Draw and label mean high water mark
Draw location of on-site wastewater system
'ou will be working in the ocean hazard area:
Draw and label dune ridges (note height)
Draw and label toe of dune
Identify and locate first line of stable vegetation
Draw and label setback line under CAMA
Draw and label topographical features (optional) RECEIVED
ou will be working in an estuarine shoreline area: DCM WILMINGTON, NC
Draw and label landward limit of AEC o C T 0 4 2011
Describe terrain (slope)
VELOPMENT PLANS
Draw and label areas that will be disturbed
If a house is to be placed on lot, describe location of house
Note size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled
Describe composition of surface
Note and list fully all trees and vegetation to be removed or relocated
Show landscaping
1TE TO APPLICANT
re you:
• completed all blanks and / or indicated if not applicable?
• notified and listed adjacent property owners?
• included your site drawing/
• signed both application and statement of ownership?
• enclosed the $100.00 fee?
• completed an AEC Hazard Notice, if necessary?
FOR STAFF USE
Site Notice Posted Final Inspection Fee Received
Site Inspections
ite of Action: Issued Exempted Denied Appeal Deadline (20 days)
vised 3/2003

A
NCDETlR
rrevA
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee cemay
Director Secretary
December 6, 2011
Lewis H. Chamblee
6033 Sixth Street
Surf City, NC 28445
Dear Mr. Smith:` L���-�y►.�L^-C,C.t✓
Attached is CAMA Minor Development Permit# SC 11-18, for work to be done for Glen & Barbara
Burge at 6029 6th Street, in Surf City, Onslow County.
In order to validate this permit, please sign both copies of the permit as indicated. Please retain the
gold copy for your files and sign front and back pages of the white copy then return to us within 20 days of
receipt, in the enclosed, self-addressed envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Sincerely,
/
Shaun K. Simpson
Permit Support Technician i
Enclosures
cc: WiRO files
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement.net North Carolina
An Equal Opportunity\Affirmative Action Employer Naturally

AIM
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Dee Freeman
Governor Secretary
November 16, 2011
[e-mail]
2 Pages
Star News
Legal Advertisement Section
Post Office Box 840
Wilmington,North Carolina 28402
Re: Burge Minor Public Notice
Kyle: Please publish the attached Notice in the Friday, November 18, 2011 issue.
The State Office of Budget and Management requires an original Affidavit of Publication prior to
payment for newspaper advertising. Please send the original affidavit of the published notice to Melissa
Sabastian, 400 Commerce Avenue, Morehead City, N.C. 28557 [phone].
Please send the original invoice and a copy of the affidavit for payment to Shaun Simpson at Division of
Coastal Management, 127 Cardinal Drive Extension, Wilmington,NC 28405, 910-796-7226.
Paying by Credit Card (number on file with Elsa Lawrence, Ref acct # 796-7215). Please send a fax of the
credit card receipt to me.
Thank you for your assistance in this matter. If you should have any questions, please contact me at our
Wilmington office.
Sinc ely,
Shaun Simpson
Permit Support Technician
Enclosure
cc: File Copy
Michele Walker DCM
127 Cardinal Drive Ext.,Wilmington, NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement.net North Car o l l n a
An Equal Opportunity;Affirmative Action Employer Naturally

CAMA MINOR PERMIT NOTICE
Pursuant to NCGS 113A-119(b), the North Carolina Division of Coastal Management, an
agency authorized to issue CAMA permits in areas of environmental concern, hereby gives NOTICE
that on November 15, 2011 Glenn & Barbara Burge applied for a CAMA permit to install a roof over
existing deck at 6029 6th St., adjacent to a canal off Stump Sound, in Surf City, Onslow County. The
application may be inspected at the address below. Public comments received by December 3, 2011
will be considered. Later comments will be accepted and considered up to the time of permit
decision. Project modifications may occur based on further review and comments. Notice of the
permit decision in this matter will be provided upon written request.
Jason Dail
Field Representative
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
Phone: [phone]

CANIA - PERMIT
APPLIED FOR
fPROJECT: A ! _ : • • as . _ - _ 5 • _ _ _ • - o •
over existing deck at 6029 6th St., adjacent to a
6 . ,
County.
COMMENTS ACCEPTED THROUGH December 3, 2011
APPLICANT: FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
L. H. Chamblee (for Burg)
6033 Sixth St. 127 Cardinal Dr. Ext.
Surf City, NC 28445 i
_Jason ■ aii 07 A_7��a1

A.1,1441
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Dee Freeman
Governor Secretary
October 10, 2011
Glenn and Barbara Burge
5759 Dove Drive
Hope Mills, NC 28348
RE: INCOMPLETE APPLICATION ADDITIONAL INFORMATION REQUIRED
APPLICATION NUMBER- SC 11-18
PROJECT ADDRESS-6029 6th Street, Surf City, NC
Dear Mr. Burge:
The Division of Coastal Management's Wilmington Regional office received a CAMA Minor Permit application from you on October 4,
2011,for development activities at 6029 6th Street, in Surf City, Onslow County. In reviewing your application,we have discovered that
additional information is needed to complete the review process.Accordingly, I am requesting that you submit the following additional
information to this office:
1. Please complete and return the enclosed Agent Authorization agreement form. By completing this form, you
allow Mr. Lewis Chamblee authority to apply, modify or amend any CAMA permits on your behalf.
2. On the permit application, please indicate the amount of impervious or built-upon area proposed in the 75'Area of
Environmental Concern(AEC).
3. On the workplan drawings, please show the location of the 30' Coastal Shoreline buffer,the Normal High Water(NHW)
line and the 75'Area of Environmental Concern (AEC).
4. Please indicate whether or not the proposed addition will be installed above existing impervious surfaces or if will be
installed above vegetated ground.
In accordance with the Department of Environment and Natural Resources regulations, we note that a certain time has passed while
the application has remained in our office. Upon resubmission of a complete application, a local decision will be made in 25 days,
provided this period is not extended as provided by law. Please contact me at 910-796-7221 if you have any questions.
Respectfully yours,
Jason Dail
Field Representative, Division of Coastal Management,127 Cardinal Drive Extension,Wilmington, NC 28405
Cc: Lewis Chamblee,6033 6th Street, Surf City, NC 28445
•
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement.net NorthCarolina
An Equal Opportunity t Affirmative Action Employer Naturallli

AFFIDAVIT OF PUBLICATION
STATE OF NORTH CAROLINA P//1 /
COUNTY OF NEW HANOVER
CAMA MINOR PERMIT NOTICE Before the undersigned,a Notary Public of Said County and State,
Pursuant to NCGS 113A-119(b),the
North Carolina Division of Coastal
Management,an agency authorized Keith Raffone
to issue CAMA permits in areas
of
hereby
concern,
gives NOTICE that on November 15,
2011 Glenn & Barbara Burge ap- Who,being duly sworn or affirmed,according to the law,says that he/she is
plied for a CAMA permit to install a
roof over existing deck at 6029 6th
St., adjacent to a canal off Stump Controller
Sound, in Surf City, Onslow County.
The application may be inspected
at the address below. Public com-
ments received by December 3, of THE STAR-NEWS, a corporation organized and doing business under the Laws of the State of
2011 will be considered. Later
comments
on e d up will
be
timeaccepted
of pe and North Carolina,and publishing a newspaper known as STAR-NEWS in the City of Wilmington
it
decision. Project modifications may CAMA MINOR PERMIT NOTICE Pursuant to NCGS 113A-119b,the North Carolina Division
occur based on further review and
comments. Notice of the permit of Coastal Management,an agency authorized to issue CAMA permits in areas of
decision in this matter will be pro-
vided upon written request. environmental concern,hereby gives NOTICE that on November 15,2011 Glenn&Barbara
Jason Dail,Field Representative
Division of Coastal Management Burge appli
127 Cardinal Drive Extension
Wilmi45
Phonne:(9108796-7221
was inserted in the aforesaid newspaper in space,and on dates as follows:
11/18 lx
And at the time of such publication Star-News was a newspaper meeting all the requirements and
qualifications prescribed by Sec.No. 1-597 G.S.of N.C.
lit/
2 Title: Controller
worn or affirmed to,and subscribed before me this Ai _day of
,A.D., .2 0 I I
In Testimony Whereof,I have hereunto set my hand and affixed net iGG'gf.4*day and
year aforesaid. .�`�Q� 0 /�.
:C0?-elleeeiV666P.1(7 - -4•:,,,
'III 'd ,'Nota Public
//__//� ,� t'C 3
My commission expires !lOT day of CzU ,20! �9 r
,,•
Upon reading the aforegoing affidavit with the advertisement thereto annexed it is adjudged by the Court that the said
publication was duly and properly made and that the summons has been duly and legally served on the defendant(s).
This day of ,
Clerk of Superior Court
MAIL TO:

I
ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
6-44
II hereby certify that I own property adjacent to "' ` 6 a'" e '�
�j (Name of Property Owner)
/�
property located at `�°( - 1 . tzi-
Address, Lot, Block, Road, etc.)yy �
on , in c J�-� , N.C.
IWaterbody) i (T n and/or County)
He has described to me as shown in the attached application and project drawing(s), the
development he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
/12/
S' a‘"' j
"T C t-11 e s Sr
RECEIVED Print or Type Nam ff
DCM WILMINGTON, NC 911 (O3I 4 06,7
OCT 0 4 2011 Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to tC LY ( )51,epve . /.//. '6�
Q �
(Name of Property Owner)
property located at (p 0 62- ( 5 .gh
Address, Lot, Bloc , Road, etc.)
on , in S _ , N.C.
(Waterbody) (Town and/or ounty)
He has described to me as shown in the attached application and project drawing(s), the
development he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
- C
!gnat
Viz i(tol>16/ rflietc,
Print or Type Name
1 1 �� 7 � 7S'
Telephone'Number
Date
RECEIVED
DCM WILMINGTON, NC
OCT 0 4 2011

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Dee Freeman
Governor Secretary
October 10, 2011
Glenn and Barbara Burge
5759 Dove Drive
Hope Mills, NC 28348
RE: INCOMPLETE APPLICATION ADDITIONAL INFORMATION REQUIRED
APPLICATION NUMBER- SC 11-18
PROJECT ADDRESS-6029 6th Street, Surf City, NC
Dear Mr. Burge:
The Division of Coastal Management's Wilmington Regional office received a CAMA Minor Permit application from you on October 4,
2011, for development activities at 6029 6th Street, in Surf City, Onslow County. In reviewing your application, we have discovered that
additional information is needed to complete the review process. Accordingly, I am requesting that you submit the following additional
information to this office:
1. Please complete and return the enclosed Agent Authorization agreement form. By completing this form, you
allow Mr. Lewis Chamblee authority to apply, modify or amend any CAMA permits on your behalf.
2. On the permit application, please indicate the amount of impervious or built-upon area proposed in the 75'Area of
Environmental Concern(AEC).
3. On the workplan drawings, please show the location of the 30' Coastal Shoreline buffer, the Normal High Water(NHW)
line and the 75'Area of Environmental Concern(AEC).
4. Please indicate whether or not the proposed addition will be installed above existing impervious surfaces or if will be
installed above vegetated ground.
In accordance with the Department of Environment and Natural Resources regulations,we note that a certain time has passed while
the application has remained in our office. Upon resubmission of a complete application, a local decision will be made in 25 days,
provided this period is not extended as provided by law. Please contact me at 910-796-7221 if you have any questions.
Respectfully yours,
on Dail
field Representative, Division of Coastal Management,127 Cardinal Drive Extension,Wilmington, NC 28405
Cc: Lewis Chamblee, 6033 6th Street, Surf City, NC 28445 RECEIVED
OCT 2 1 2011
DCM WILMINGTON, NC
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement.net NorthCarolina/
Natural!'
An Equal Opportunity 1 Affirmative Action Employer to a"!'

A7A,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: d1)/o2p/o24
Name of Property Owner Applying for Permit: Namep of Authorized Agent for this project:
4 E f.O /S• CNfim .L E
Owner's Mailing Address: Agent's Mailing Address:
5759 --Do v E �h'1 i F O3_ 6 S Ti€ 2— T
-oto F. ( 1,i.L , /V C /.4 F CI Ty NC as 4i-it5
a '3y-8 -/70'7
Phone Number(910) "fa5-987ii- Phone Number( 9/D) 5387- 7 73.5"
I 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):
A --w-rnrer-cao—,r‘• -1-244-fr"-a—X rzostrV itee—ria-4,to— IA 44;toti 72141—
(my property located) at In S i2E T F C/7-
This certification is valid thru (date) / L/3 I D/
,•i-a›V-A5.- 217. -u- -a /0 O a D//
Property Owner Signature Date
RECEIVED
OCT 2 1 2011
DCM WILMINGTON> NC
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement.net NorthCarolina
Naturalh&

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RECEIVED
DCM WILMINGTON, NC
OCT 0 4 2011
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