Jean Beasley 72804D

,CAMA / DREDGE & FILL No. 72804
I GENERAL PE) Z _PERMIT ) '`r' Previous permit# /ki1 i C� j
—iNew _Modification Complete Reissue ['Partial Reissue Date previous permit issued Apt. ZDQ, j
As authorized by the State of North Carolina, Department of Environmental Quality r
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7 f
r� iy ',Rules attached.
•
Applicant Name JE, ?" / / Project Location: County Pf(J ( ~4—
9
Address 7 (!` . S (to✓E b e _I Street Address/State Road/Lot#(s) '
,�Ate.-- C /
' City r F. C.,f State NG)zIP Z(14T 5 'U 7 . S e '''' f ,
Phone# ?70 '/?0 E-Mail Subdivision ii "'
( ) c 'v 61 ZIP 7 5
Authorized Agent ��t�/�/Jfi1i✓ ��/6u��.• City /��""�,�.
470`" d River Basin I l 1'k k a ,
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Phone# ( ) Mir
Vv D
1OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body /+"T i' �' 4"- at man /unkn)
AEC(s):
❑ PWS: �f
Closest Maj.Wtr. Body A.ti
G
ORW: yes / no PNA yes
i Type of Project/Activity ✓`` a4>1. f�IV r. V?i` 1�
I (Scale: / fr%Zc) f )
Pier(dock)length f
1
Fixed Platform(s) I . ^f,
V
Floatings
Platf. orm . { I 1 1
Finger pie(s) I r
Groin lengti + ��
number '' LL I r Vt
Bulkhead/Rip p length `j j r-ef kAir---
avg distan offshore 4 t'PeTN: 7 ( ( I
i max distant offshore .` • 01111111% /-r CN
_�
iAl. ,, ,,'
Basin,channel , I CS
cubic yards "", 1
Boat ramp t j I r'` l'"
Boathouse/Boatlift , t.,A. 57‘eV it/0 ,
Beach Bulldozing ro/L
Other I i I
l ee
i
Shoreline Length '
i
SAV: not sure yesj --- — { ;
I Moratorium: n/a yes
Photos: yes
/!L Waiver Attached: yes . o —1.---- ' +vv�'++' ,
A building permit may be required by: S',Ie` e---(7, . H See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) ,
Notes/Special Conditions I2L ., rc1/ S•/'�.-4"kc �J ,ei(/e7//i4� 1�0- PI -
b%1/ 6:fru fritt) caVo(i' -it. // A 4497e i
--P-4<r_121-40X) 4' 7 5)910 ir-
10
I / d ' t!" AA, .... /11^/ (1/9/A4/ /6214() ne) i'v A' 774/ /4)/4'14.
/ / Am 2:5 ,
AA4-t-
A C
Age r licant PrintedJNatn Permit Officer's Printed Name
- .--- ::._91/ ' ,vtc-e-4------
Signature **Please read compliance statement Ord[IF
�ac�c.Qf„p'e�rr,�it1 `�, Signature J � ____:„.„-:/
/ : 3— � —.
Application Feels) b I '3 e c —Z�}`1 Issuing Date Expiration Date
a .

. AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: SORN
Mailing Address: gko `.�Ouii* 5 H&V v- t7 V
C►-ri/ ?
1
Phone Number: ( q\o) 4-i0
Email Address: 1 O the a D�-D\ ' r. m
�g
I certify that I have authorized 'j 4 . Marl Vl
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: SUir\ . 10./LO Y.,kr
. 0
O. alb to O!)V V 11(l
at my property located at 61 A o 5 • ShGm,
in Pnrv\-P\ County.
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
PON' LEY
Print or Type Name
Title
JO 1 I
Date
This certification is valid through I I
l

NC DIVISION OF COASTAL MANAGEMENT
SANDBAG REMOVAL NOTICE
I, e/A ( IP , understand that saridbags are temporary erosion control
structures that may remain in place(duo to hid:years after the date of approval if it is protecting a building
with a total floor area 05000 sq:ft.or less, or,for up to five years if the buikling has ei total floor area of
more than 5000 sq..ft A temporary erosion control structure may remain in place for up to five years if it is
Protecting a bridge or a road The property owner shall be responsble tor *naval of the temporary
structure within 30 days of the end of ttie allowable time period.
In this case the sandbag alignment may remain in place up to:
two years after the date of the attached permit approval.
Removal Date:
)< five years after the date of the attached permit approval
Reitioval Date:
Address of the Structure Being Protected: S ep:r
üRt ecty NO_
Property Owner _ 42p_a5\e _
-Firm, • • •;• or kdvidual-
if the property is owned by a Firm or Corporation
give the name of the officer or authorized
Representative: _ Date;
Print Name
Sktriature-
it.H.•••••ItileMInit.111141
tgling*tt
If an agent is obtaining the permit-on your behalf the following section must be completed in full:
2
give permission to, e) Ai\o‘Ovie.
Print owner or Officer Name Print Agent Name
to act as my/our agent in obtaining a CAMA General Permit to place sandbags on the property noted
above.
Permit Number:
Property Owned Otker Signature a

.2X
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name-of Property Owner. Ul P 71.‘-j l-
Address of Property: - "I 2-6 6vUTC�- _-S- DK d CARP ei-ry/ Aic ?cg-txR
(Lot or Street#, Street or Road, City&County) e2 oz+ si
Agent's Name#: Mailing Address:
Agent's phone#:
Agent's email:
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 drawin• the develo•ment
they are proposing.
`7 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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at(910) 796-7215. 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, boathouse, lift, or groin 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.)
n
Ivr/Pt I do wish to waive the 15' setback requirement.
(J R' I do not wish to waive the 15' setback requirement.
(Pro erty Owner Information) (Adjacent Property Owner Information)
Si e Signature
-Se-Q.V\ I3 0,0tG'-PA . \„t ,`,_ i .4,. C,4C(
Print or Type Name Print or Type Name
c5PAJrt4- 6-14-Dr-e DO_. 4- 2, v E a_5 6, o -Da,
Mailing Address Mailing Address
ugr UJ-ry
i'\)
Agziz
City/State/Zip / City/State/Zip
(410 77 - ?g®o 302 . a3G. Q04ct /,, tz,k, k
Telephone Number Telephone Number e c.ti o., ,c a-w,
1 -30' 1 q a it J ao i
Date Date
Revised 6/18/2012

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Nam&of Property Owner. _3-Q-1tJ \ e- a-5le
•
Address of Property: -"4 u TL-v 5 1+0 l,/(z.., -1,(A'C- eitty cieibtaer
(Lot or Street#,Street or Road, City&County) 8
Agent's Name#: Mailing Address:
Agent's phone#:
I Agent's email:
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. 4Tfe a oii l iifiw—itiii �., iiiti e n ilhV e e .
y`Y)`v✓L 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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at(910) 796-7215.No response is
considered the same as no objection if you have been notified by Certified Mail.
i WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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) (Adjacent Property Owner Information)
Si; ,1 , e Signature
� /
Je ill l I l� l' /U c p nn O
Print or Type Name Print or Type Name
(1 D (01A- f E 1) E De Db/id
Mailing Address Mailing Address
5f0R1:-- ty ,-)?l'84-q6 ) 1(6--E.c. ()AY 9
City/State/Zip City/State/Zip
(`11I O 7 --VS ©D - 6, 75- 306
Telephone Number Telephone Number
/—O_ - �' +•.� o ► moo /
Date Date - -
Revised 6/18/2012

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Check
Dab Received Date Deposited Check From(Name) Name of Permit Holder Vendor Check Number amount Permit Number/Comments Receipt or Refund/Reallocated
Creme Column2 Column3 Column/ Column, Column/ Colunm7 Column8 Column9
2/112019 Brandon Grimes Mane Order 1 of 2 Jon Beesley BwnFket.North Amer.MO 181332791 $ 200.00 GP 072804D JD rot 7783
2/112019 Breadon Grimes Money Order 2 of 2 Jean Beasley BameFket Nord,Amer MO 181332792$ 200.00 GP 072804D JD rot 7783