Bryan Shirtliff 72231D

do.
11
gi�pp►, CAMA / -,DREDGE & FILL NO 722-- A B C D
1WGENERAL PERMIT Previous permit#
> •'' C-New -Modification iComplete Reissue E.Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ,`�7
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC C// ���
�j des attached.
Applicant Name r AAA / � ��./ii Project Location: County f c•
Address Il' 4-IO�k I/4« r/ Street Address/State Road/Lo #(s)
7 / J State/�� ZIP v! 1 `, (� .S �.t%i^ i .
City � /ryt � � ��
�'},� /JGC/ Subdivision
Phone# `-F-f l/ " ; -r l E-Mail
Authorized Agent ,ramc'ffiA t/ 1 City N ' 1 0 5 { 6Ci ZIP -//C( C U
❑CW DI EW ❑PTA ❑ES ❑PTS Phone# ( . —50 River Basin ni t; j Cell.
Affected
AEC(s): VI oEA DIHHF Cl IH ❑UBA ❑N/A Adj.Wtr. Body A/ ( /man /unkn)
El PWS:
/7-A01-4--
Closest Maj.Wtr. Body (9 .10- ^-
ORW: yes / no PNA yes keS
Type of Project/Activity l4 , f Q(/ a-.14cI 6-
(Scale: 1 f= )
Pier(dock)length
i i i
Fixed Platform(s) IIII'fiijll
Floating Platform(s) ■ ■ IM MMEMMI IMM
Groin length
I
III.. ► ,er
number 111111111111111r
�jl� � � r�a!
■!!!!■!!!I I■U um inum m um EN mu !j < Uwf
Bulkheaddistan p lengthIIIII!!�!'1111111 1011111III1I1III lid
�
max distance offshore IL1H111111111!!!!!!!Basin,channel 111111111111110111
_
Il i,!!!■!El1:�!!!=!!�'MNSI I!!`:iiuu ia!!!!!!
cubic yards 11!!!!!!l,,1yy1lIIIuu .�• �m■�a!!!N!!!i1\�w!!! .
Boat ramBoatlift iIHhIIIIIHhIIIIIIIIHIkIIIiIIII .
Boathouse/ "!!!!!!!!S!!!!!!!!!!UU�m1!!!!!!lrlu�Zii, ,
INII!!!!!■!!!!!!RUUr�nmaai!!■!!!■!r�
!!■!!1.111I:9L1URUU!!!!!!lI7Z L
Beach Bulldozing !!Ii5!111!1IIIillllIll
Other atc I, pilimo
421:::::maisIIIIII 1
A ,
Shoreline Length '� ;11'"
SAV: not sure yes no1 '
Moratorium: n/a yes no i 1111111111
Photos: yes no i I
Waiver Attached: yes no I .
_ /,�A building permit may be required by: I ''See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
rmit fficer's Printed NamE�
%a?ntedNamel ' f (
� fir- _...,,
Sign ure Please read compliance statement on back of ermit Sign /ure / /(i ' ilk
it/ '—+--. i 7-Z /C' .g • /t Y
Application Fee(s) Check# Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: l3lzynn tt .S)3» t - 9
Mailing Address: f 6014 •
G 17D 1 I
Phone Number: 7/ 7 3z' 3JD7
Email Address: l3 944ri.44-'‘),�.�1�i9��. e ur'
I certify that I have authorized )3 n1 2 4410� �nt
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 5)4,.6 13AG S
at my property located at '1 219 1-52i Gsz.biIc ✓9Or+cf )-ce Se LL, /3c,,e..)/ ,l� G
in oS County. ZB Lit
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this •
permit application.
Property Owner Information:
Signature
13) S 33 Sri ricj=
Print or Type Name •
Title
J1 / -7 / /8
Date
This certification is valid through I I o
9

f•
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner: 5R i a L0 S r)„ZTU F}
Address of Property: 1-1 ZL)$ tTS IAA D DRivc. rLs Yb6D SA)L t i ci. n.C,
(Lot or Street 4, Street or Road, City&County)
Agent's Name#: Mailing Address:
Agent's phone#:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing.wIlh dimensions,must be provided with this letter. •/ t.
EGEi E-
I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed,you must notify the Division of Coastal Menagement< NOV Q 7 pia
(DCM) In writing within 10 days of receipt of this notice. Contact Information for DCM offices it available at http://www.nccoastalmanAgement.not/web/cmislati-listing or by calling 1.888-4RCOAST.No response is considered the same as no objection if you have been notified by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15'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 to waive the 15' setback requirement.
X I do not wish to waive the 15' setback requirement,
(Pro arty er Information) (RI rtan Prop Owner Information)
Sign( nre Signature
/31t 14A $h'AJ24'r item- e i0tjico,i , •
Pont or Type Name Print or Type Alamo
5444,744 Aihic 13s2(e ATERNJIL. 61Fr
Mailing Address Melling Address
( 'p Thu. el) /701/ 3I(6-E+t_*NQ M( 20))'2
City/Slate/Zip City/State/Zip
7)7 2°1 9lD7/3S)hnZ`t,ly'r"iiPiz;I.Ait.. tom 41 a'43` kilo sb &-r o_Tke tk6srTv,(u , 11
Telephone Number/Email Address Telephone Number/Email Address • •
p, ,AI,n,
Ii .+ lt•� •
Dale
D
Date44
(Revised Aug. 2014)

•
f E.
CERTIFIED MAIL • RETURN RECEIPT REQUESTED NOV 0 7 2018
DIVISION OF COASTAL MANAGEMENT Ay.
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: OP./An a Lv)E S HI)2TL4 4-
Address of Property: `)Z )g S4f o /lorvr)•I 1'vPS4iL boy 6•C.
(Lot or Street#, Street or Road, City&County)
Agent's Name#: Mailing Address.
Agent's phone#:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
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. Contact information for DCM offices is
available at http://www.ticcoastalmanagemeramet/webicmistaff-listing or by calling 1-888-4RCOAST.
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, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15'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 to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro erty er Information) (Riparian Property Owner Information)
I
ti7�n[l ttre Signature
A114A .St)/11rz1
Print or Type Name Print or Type Name
51114)d, 21916
Mailing Address Mailing Address
( Q rhu 9i )70)1
City/State/Zip City/State/Zip
7)7 3 2/ 91D 7 / S))»zi-1..o:fr-VizitAii). (oM
Telephone Number/Email Address Telephone Number/Email Address
Date Date
(Revised Aug. 2014)

QacoSign Envelope ID:DE329949-C43A-4B5D-8CBF-E71A21E3FAD7
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:E TG Do nG. ICI 1 .o yvv (250✓1
/
Address of Property: f Sy LS 16- ))I v Te /v ( Z S y b 0
(Lot or Street#, Street or Road,City&County)
Agent's Name#: Mailing Address:
Agent's phone#:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they
are proposing. A description or drawing, with dimensions, must be provided with this letter
' T I have no objections to this proposal. I have objections to this proposal.
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. Contact information for DCM offices is
available at http://www.nccoastaimanaciement net/web/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15'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 to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
,-DocuSigned by'.
Ani
Si9latarEF693F24A2 Signature
(r t Jr i t ,M �?/1 1�, e
Print or Type Name 1 / Print or Type Name
11-1I Ciei te.w�>
Mailing Address Mailing Address
hPC•‘_ Fe e[1 /vc (I 6
City/State/Zip City/State/Zip
91, - 37h - ON7
Telephone Number/Email Address Telephone Number/Email Address
1 1 ^ v 1
Date Date
(Revised Aug. 2014)

SANDBAG REMOVAL NOTICE
TO WHOM IT MAY CONCERN:
I, 13) $ (4 xZ�ti�,r , give permission to
to act as my
agent in my behalf in obtaining a CAMA General Permit to place sandbags
as a temporary erosion control structure in front of my property at
S I4 1 #t= , have read the specifications
in 15A NCAC 7H-0308(a)(2) and understand that the sand bags may
remain in place for up to years after the date of permit approval. I
understand that I will be responsible for removing the sandbags within 30
days after that date or at any time that they are determined by DCM staff or
its agent to be unnecessary due to relocation or removal of the structure. I
will also be responsible for removing any damaged sandbags during the
period they are authorized to be in place.
I also understand that the removal of the sandbags shall not be
required if at the specified date for removal they are determined by DCM
staff to be covered by dunes with vegetation sufficient to be considered
stable and natural.
AUTHORIZED SIGNATURE:
DATE: J/ $,45

J/if‘ )0tvoolN
‘ \ .
di- -G\
, [\ '
fi ' ,
c
( v
,Q. \-k) ,
, \to ,
4e 0(eed e, '
'fQ1 ie - \-)-,
c)) tf ct9 twi S
ter S
41 taiiirartair00- ---- .
•
,___________:
`, dIUWARAwl-niPAEVEEIM, _---. ..p._ if
:
___.............
. • , (( ) , 6
. 124 , ,
v )c (t t,4 pc - S—(--

Date
Date Received Deposited Check From(Name) Name of Permit Holder Vendor Check Number Check amount Permit Number/Comments Receipt or Refund/Reallocated
Columnl Coiumn2 Colurm3 Column4 Column5 Colmmt Column? COMM* Column9
11/9/2018 B and B Marine Construction Brian Shirtliff Wells Fargo 1972 $ 400.00 GP#72231D JD rct.6955
11/9/2018 Clements Marine Construction Inc Lee Prevost and William Benson First Citizens Bank 4993 $ 400.00 GP#71742D TMc rct.7301
i e
GN