74400D - Avabea

_' CAMA / DREDGE & FILL No. 74400 A B C
GENERAL PERMIT Previous permit #
New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As aut ri*d by the State of North Carolina, Department of Environmental Quality /
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC a i1 •' f (�fJ
//�1 R I hed
Applicant Name Vec'4S _ A",, "' 6 e
Address Sr21, A L-J i lei S Q .
r
City ''3 1 n.. e541%J 4 �, e_ State 5 C ZIP 2 9 X/
Phone # ( A 43 VfWZ, E-Mail
Authorized Agent
Affected ❑ Cw ❑ EW DVTA CkES j "S
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PwS:
ORW: yes PNA yes G
—� u es attac
Project Location: County \ i,, /' S w 4
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin �L� �- '—✓
Adj. Wtr. Body U S mac` (— C Jac, YCL In/man /unkn)
Closest Maj. Wtr. Body At / '
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Agent or plicant Printeld
Name
Signs4re"Please ead compliance statement on back of permit"
0
3R
Applica nFee(s)
Check#
I (� J_ - k�
Permit Offi Tinted ame
Signa1-z
? 1-2 L Z D
Issuin Date I Expi atio Date

-Y WA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis
Governor Director
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit:
Owner's Mailing Address:
'-�o (.) yy� n k I
S11iw,�-MonLit .15C
Dee Freeman
Secretary
Name of Authorized Agent for this project:
3�Y'r
Agent's Mailing Address:
q LJ ) C, occ"--, R-, C& -
5(AC.Uc. a-74')y
Phone Number (4yt;,44 4 3 ,�, — 5 3 5 � Phone Number (milIO) qY � — vR0 �
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):
5C7 r:�rj1%4eort) `vtrrle Ir
1
For my property located at 1 ?1-
This certificati�y is valid thru (date) ! _ �o— a 6
Owner Signature
Date
127 Cardinal Drive Ext., Wilmington, NC 28405
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
On
e M Narolina
Naturally

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to a -s
(Mani �Property wner)
property located at
on
(Waterbody)
i
Block, Road, etc.)
in C4-- >
(Town and/or County)
I .
Applicant's phone #:$� q''W — 9�1 g '57 Q ftt�`�-� rl 'i,l%' D� CD
ailing Address:, n p
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
,�t
-------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian k
Own Information)
for Permit) C
Mailing Address ff Signature
-tUVOSor) 111(LIC
City/State/Zip
Telepho u ber
Signal re Date
Print or Type Name
Telephone Number
Date

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(i ame of Property Owner)
property located atI�
(Lot, Block, Road, etc.)
on , in 6I P 19.cp C , N.C.
(Waterbody (Town and/or County) \
Applicant's phone #: !(o �—(43D—C?351? Mailing Address: S/ � .� 05
He/She has described to me as shown below the development he/shame is proposing at that location,
and I have no objections to the proposal.
-----------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone].
No response is considered the same as no obiection if you have been notified by Certified Mail
(Property caner I formation) (Rip ' n `vn r formation)
Signatur Signature
XA.
Print or Type Na a Print or T ype Name
Mailing Address Mailing Address
10—
City / Stale / Zip City / State / Zip
Telephone Number LJ "[
/ L 3a 1c 35 Telephone Number.
Date 2 1 Date l�
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastaimanagement.net
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to s
(Name of Property Owner
property located at
Road, etc.)
on , in
` , N.C.
(Waterbody)jf— �((Tawnanounty)
Applicant's phone #:%�LYt-3A 93S_RMailing Address: s
15� n�,Ile- 5_c a9�8/
I Ie has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
---------------------------------------------------------------------------- -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
....:...........
------------------------------------ e
for Property Owner Applying (Riparian Property Owner Information)
for Permit)
5Ja aAsl��
Mailing A dress
St f s�
City/Sta e/ ip
45Cc4-�3D-935
Teleph a Number
Signature
Print or Type Name
Telephone Number
Date