59379_EFIRD, CHARLES_20111108

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/^ ,�,CAIVIA / ` - DREDGE & FILL
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G E N E W L PERMIT Previous permit #
New ❑Modification -Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
© Rules attached.
Applicant Name_ �:> &Z;'.-c? Project Location: County L,`'.�1- -V
Address 30 6 - " '� � Street Address/ State Road/ Lot #(s)
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City- 'Jck6 A `Itz State_ ZIP 2 f �.� iO
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Phone # Fax # (`)
Authorized Agentjt
Affected ❑ CW [ EW PTA O ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA O N/A
❑ PWS: ❑FC:
ORW: yes /'�o PNA yes / eo Crit.Hab. yes / no
Subdivision
City i.., �:.. j ZIP
Phone # ("sil ) .7; `'1 r - 5 ('�� River Basin
Adj. Wtr. Body A � �''�_� ate man unkn
Closest Maj. Wtr. Body '� Vj
Type of Project/ Activity l ",�• �
(Scale: f �� 16 ' )
Pier (dock) length -_
Platform(s)
i
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore_ ---
Basin, channel
cubic yards
Boat ramp
Boathous Boatfi t
Beach Bulldozing
Other
Shoreline Length f<t 6
SAV: not sure yes to
Sandbags: not sure yes
Moratorium: n/a yes
Photos: yes e. `
Waiver Attached: no
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A building permit may be required by:
Notes/ Special Conditions
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
I1Ute
Issuing
❑ See note on back regarding River Basin rules.
9 116 112
V h.l 0 L+ l a -,/—A T+i
Local Planningjurisdiction Rover File Name

1101
66-21/530
BRANDON D GRIMES BRANCH 77667
9045 9th St
Surf City, NC 28445
a Pay to the
order of
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Dollazs
®® ACHOVIA
Wachovia Bank, N.A. �
waohovia.com For L LO L
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date / I- `1 I I
Name of Property Owner Applying for Permit:
Mailing Address:
306
T��w�� : Ns s�-�v
I certify that I have authorized (agent) 1 r G r fri e-5 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) ,/ ; ur 1't
at (my property located at) G b- Aov-C" -y 0 r,
This certification is valid thru (date) ( I— — 1)—
J
Property Owner Signature ` Date
_ j

ADJACENT RIPARIAN PROPERTY OWNER STATElENT
(FOIL A P1EB/VI00jUXG PI LLVGSIBOATL1FT/BOATH'OUSE)
I hereby certify that I own property adjacent to
(ti'ame of Property Owner)
property located at � C' � � �'�'"'-'^'' (J ��
1(Lot, Blocl ,�o�td, eta•}
( l� N.C.
(Waterbody) (T�— own and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
back a minimum distance of fifteen feet (151 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 not wish to waive
�,Nc I do wish to waive that setback requirement.
----------------- -- ----- -- ---- _-..---------------------- ----------— ------ —__-- ----- . .
......
. _ - , DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(76 be filled in by individual proposing development)
, —1C (1—
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tf you have objections to what is being proposed, you must notify the Division or Coastal Management (DCM) in writing
within 10 days or receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
1)CM representatives can also be contacted at (910) 796-72151
Ng response is considered the snme wgpro obieclion ifvqu have hecq notified U Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
Mailing Address
Ar
City/statelzip
Tjelephona
Signature Date
(Riparian Property Owner nformation)
ti..
Signature
Print or Typo Name
3316 -G 76 -S�73 S -
Telephone Number
ate
127 Cardinal Drive Ext., Wilmington, North Carolina 28405.3845
Phone: [phone] ti FAX, 910.395-3964 1 Internet WWW nccoastalmanagement,net
An Equal Opportunity 1 ANlrmalive Acton Employer - 50% Recycled 110% Poet Consumer Paper

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