73689A_Horne, Kathy_20190802

CAMA / . DREDGE & FILL
GENERAL PERMIT
-INew ❑Modification L1Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Applicant Name Ko+kq 140t rJ
Address-4-1 W ,\ c\ 5 we L... c
City S. '-V 1" , S k u + < \ State iv,c ZIP a�S Li S
Phone # ( ) E-Mail
Authorized Agent ttiur 1►u< t �. / . , r- e k - I
Affected ❑ Cw ❑ EW X PTA ❑ ES K PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / r� PNA J§P no
No. 73689
Previous permit #
® B C D
Date previous permit issued
14I100
A Rules attached.
Project Location: County pc f e
Street Address/ State Road/ Lot #(s) :q'4 d 5,,,,,,, l
Subdivision
City ShO4'c '�' ZIP pL 74,i t, 5
Phone # ( ) River Basin Pe,� T I
Adj. Wtr. Body le, (�,. C y �,(rtym�an /unkn/unkn)
Closest Maj. Wtr. Body SL),, .-%C4
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INAMME
M ME mom ME
MENEM No M■■ENmom v '■■
or Applican Printed Name
Sign a Please read compliance statement fin back of permit*
400.oc� i d55'�
Application Fee(s) Check #
Permi>;.O ed Nam@--•=
atU;QA
(>15
Issuing ate Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
Other:
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: I vrr�-c t tl,y Permit #: j G Y-14
Date:
Describe belo',�r the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
S
Dredge ❑ Fill j Both ❑ Other ❑
tic) Lk
-LQ
s �o( (j v .,
Dredge ❑ Fill Both ❑ Other ❑
G•
Dredge ❑ Fill ❑ Both ❑ Other ❑
60c,
3 600
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net revised:02/03/10

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
'ATA \j3'\ 0- Suoa-r-� �-n
124�
I certify that I have authorized (agent)`��-oSvcy-h+ �lcin� to act on my
behalf, for the purpose of applying for and obt:
install or construct (activity) la 0'
at (my property located at)
This certification is valid thru (date)
ining all CAMA Permits necessary to (
o net, �b-o V -he-�J
Property Owner Signature Date

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
OLO d �a Rse r�
q IS LA-) 5 �
I I III II III II III II I III I I II II I I I
9590 9402 4940 9063 8582 88
2. Article Number rrra s < 0000 7242 520
7017 0660
PS Form 3811, July 2015 PSN 7530-02-000-9053
A. Sig ture
Agent
ElAddressee
B. Received by (Printed Name) C. Date of Delivery
%_�.JL
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
]�
❑ Priority Mail Express(D
❑ Adult Signature
❑ Registered Mail-
Signature Restricted Delivery
ElRnIstered Mail Restricted
vdult
Certified Mail©
Delivery
O Certified Mall Restricted Delivery
❑ ReturnReceipt for
i Delivery
Merchandise
i Delivery Restricted Delivery
El Signature ConfirmationTm
ail
❑ Signature Confirmation
❑ Insured Mail Restricted Delivery
Restricted Delivery
Domestic Return Receipt

First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
9590 9402 4940 9063 8582 88
United States
Postal Service
• Sender: Please print your name, address, and
Northeastem Marine Construction Co,
P. O. Box 42
Kitty Hawk, R C. 27949
- -�, 261-36a2
in this box* I
1111,lilili,i�►►li►li,in,11,i,Ililli,liilllili„i'illiilli"ilia

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to
(Name o roperty Owner)
property located at
1CL r) L.
(Project Site: Address, Lott, Block, Road, etc.)
one. 1t'� 11 \ l C-V�,e , in �o-� 1 A•l 111 C'� AL 1 -`;� N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: L\CC2 mark - Mailing Address: - a_ t
Agent's phone #: o JrA �a.r� 1 � �� °
He/She has described to me as shown below the developmen e/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rM in description below or attach a site drawing)
0+ P 1-0 L� I CA f�k�
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 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901 No response is considered the same as no objection if you have been notified by Certffed Mail.
(Property Owner Information)
Signature
4n, r-n e,
�_
t'f y
Print or Tye ame
11h W1' 0 1'-Ak3 n �
Mailing Address
t)G (;�I G 4 q
City/State/Zip
Telephone Number/Email Address
iCI
Date
`Valid for one calendar year after signature'
(Adjacent Property Owner Information)
Signature-
-�AV1-P 13AKKi iJ
Print or Type Name
75- w, LD Si,JAti L N
Mailing Address
6 vv<k-rG2N 2-7 l0
Cit &ate/Zip
Telephone Number/Email Address
-7/2,�,fII
Date"
Revised Jan. 2017

40 - 0 20 40 80
1 inch = 40 ft.
New
Pi � 2©'
AN G1JITE CREEK
JE ��
eU�KHEru EX. %'
M.B. 3, WDOD • REBAR
PG. 112 126.6�
4' DEEP
LEGEND: BU�HEAD EDGE N16.153�36�C�E UNE pplLYi GK/� !�
WA �SEi I O
O Ex. Rebor OPEIl PfPE 30• aAM
a0 Ex. Open Pipe 10' DEEP
0 Ex. Round CM
A Ex. PK Nail
® water Meter 00
OPEN PPE �
■ Phone Ped. FLUSH O 5
AL CATV Q°
125.11'
~
o
Fire Hydrant
I
a Ex. CM
rn
Lamp Post'
(/
-- -
® HVAC I
r
0
M
CE .
W.B.
pi
-7.7
NOTE
01
PG. 301
c0
Address: 77 Wild Swan Lane
to
lot Area = 26432 S Ft
^_
e o
q.WOOD
Lot Coverage =
10,084.7 Sq. Ft. (38.2%)
WA L
Flood Zones are
subject to change
Setbacks shown
are as per the Subd.
Plat and as per
Zonings they do not
reflect any Restrictive Covenants
that may exist.
O
This survey was
based on the existing
m
property corners found in conjunction
with the recorded reference given.
W5
Ce rtifl r hereon
is not re- onsible
00
p
for utilities and/or features that are
not visible at the time of the survey,
nor, any additional setbacks that ROUND
are not shown. 125.13' PONc. MON
EX. CONC.
MON. FLUSH EQ
C
NO2'03'57-E
(TIE LINE ONLY) 128.65
WILD SWAN LANE
N
D.B. 1607,
PG. 46
10.5'
EXISTING
-UWELi_IidG
Iw
• r 8.1'
M _
N
I^ N
N
N
25' MEL
124.04' _ _
S05`42'13'E
(60' R/W)
EX. BUSTED
CONC. MON.
i 4' DEEP _
,fit jtk CAR
Q SEAL
i, M. DOUGtAS STYDNS, JR., P.LS., certify that this plat was drown from an actual field land survey n r L-32V a
that the error of alr.utrte,' by latitudes and demrtu.re* is at least 1:10,000;
Witness my hand and seal this yti3 day f A.D. 20].¢_,
I t LOT 6, BLOCK 127
SOUNDSiDE SOUTHERN SHORES
Z
SITE SOUTHERN SURVEYED FOR
SHORES
MARTIN'S \ E. KATHY HORN E
POINT
ATLANTIC TOWNSHIP DARE COUNTY
VICINITY MAP (N.T.S.) SOUTHERN SHORES NORTH CAROLINA
DATE:-29-16 F.I.R.M. DATE:09620—U6u 'c-16
EV.DATE sC��ntlLCe�
FLOOD ZONE: AE (7') 2700 N. Croatan Hwy. Kill Devil Hills, NO. 27948
SCALE: 1 = 40' REC. REF. M.B. 3, PG. 112 Phone: [phone] Fax: [phone]
ILE NO.: 16-310 D.B. 1166, PG. 100
WG NO.: 16310P PIN NO.: Ak'�,,,un �l must be uftwi use
w�for alteration o s document ,,; document
20986714246974
>>Lhe0d
•

■ Complete items 1,'2;•and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
j■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
{ 'a to
A.
X
Receiv d by (Print�ed Name) C.
D. Is delivery address different from item 1?
If YES, enter delivery address below:
Addressee
Ate of Delivery
❑ Yes/
❑ No
3. Service Type
❑ Priority Mail &press&
I
I
I I
I III
II
I II
II (
III
I
I
I'I
I
I I
(
❑ Adult Signature
O Registered MajlailTM'^'
O Adult Signature Restricted Delivery
❑ Registered Mail Restricted
Certified MailO
Delivery
9590 9402 4940 9063 8582 95
�j_Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
9. Artir.IP.. NI ImhP.r rTransfar frnm lahal) _
❑ Collect on Delivery Restricted Delivery
0 Signature ConfirmationTM
.QPrvicP
la l
7 017 0660 0000 7242 5 218 ;ail Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt

First -Class Mai]Paid
Postage & FeeUSPS
ulmm As"
Permit No. G-1
9590 9402 4940 9063 8582 95
United States
Postal Service
• Sender: Please print your name, address, and ZIP+4® in this box"
(ar l:�acstem Morino Construe C�
K0.box
42
Kitty HHawk, R C. 27949
aB a
1)1111oil 1111"Ii11�ti'�11�I111)1dill I#IIIrufill, IJill, liI,hill,

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to
+� C (Name of operty Owner)
property located at I I �►� i WWI L6
(Project Site: Address, Lot, Block, Road, etc.)
on:Ye(3_ 1 �'; l l� �rt°f , in �� I L-h P r n �Y lf� �2� , N.C.
(WaterboddyIPC)) (City/Town and/o�irCounty)IAgent's Name #:{y , moan o Mailing Address: L `1'
Agent's phone #:
He/She has described to me as shown below the development he/she 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)
5
©VF
tf 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 401 S.
Gruen St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been noted by Certified Mail.
(Property Owner Information)
Signature
Print or Type Napie
Madi g Address
c� 0 Shires 49
City/State/Zip
Telephone Number/Email Address
Date
"Valid for one calendar year after signature'
(Adjacent Property Owner Information)
Signatant-r(Q \
Print or Typo Name
*-A G6 t Ll. __> �_A1r .=
Wiling Aodress SV0TWg.4 SFbRfs
> Z -qa�
City/State/Zip
M-261-800 �4 w .ac.� . �g�ww • co..,.
Telephone Numbs /Email Add U
18 Iv L-2v,9
Date'
Revised Jan. 2017

40 V 0 20 40 60
1 inch = 40 ft.
M.B. 3, PG. 112
LEGEND:
.O
Ex. Reber
O
Ex. Open Pipe
•
Ex. Round CM
A
Ex. PK Nail
0
Water Meter
■
Phone Ped.
A,
CAN
W
Fire Hydrant
I]
Ex. CM
Lamp Post
ISZ]
HVAC
Ex. Old"
OPEN PIPE
FLUSH
Q° A
NDl PG. 301
00 m `'
Address, 77 Wild Swan Lane
n `=
Lot Area = 26,432 Sq. Ft.
WOOD
Lot Coverage = 10,084.7 Sq. Ft. (38.2%)
wET
Flood Zones are subject to change
I
Setbacks shown are as per the Subd.
Plat and as per Zoningi they do not
reflect any Restrictive Covenants
that may exist.
^�
This survey was based on the existing
O
�
C
property corners found In conjunction
with the recorded reference given.
30
Certifier hereon is not responsible
for utilities and/or features that are
not visible at the time of the survey,
or
nor any additional setbacks that
are not shown EX ROUND
1 ' 5.13' coNc. Mar+
EX. CONC. If6 DEFP
MON. FLESH
`nrn
" — — NO2.03'57"E
p9 a
(TIE LINE
ONLY)
'305"42.13--E a
NbL.J
LLI, �z�
l�
EX. %'
REBAR
4' DEEP
LLI
c0
O
�t
00
z � 5.)
I D.B. 1607,
111 PG. 46
Ex. BUSTED
CONC. MON.
, 4' DEEP
WILD SWAN LANE (60' R/W)
• Q•
I, M. DOUGIAS STYONS, JR., P.L.S., certify that this plat was drawn froan actual field land survey $ S�! m
that the error of closure as calculated latitudes and departures is at least 1:10.000:2,r,
Witness my hand and seal this JAt day f A.J. 201§_
0 LOT 6, BLOCK 127
Z
SGUNDSIDc SOUTHERN SHORES
SITE \ SOUTHERN SURVEYED FOR
JSHCRES
MARTINS E.THY HORNS
' POINT �
! ATLANTIC TOWNSHIP DARE COUNTY
VICINITY MAP (N.T.S.) I SOUTHERN SHORES NORTH CAROLINA
ATE: 1 1-29-16 F.I.R.M.: 3720 9867 00 J "C-1697" .
REV.DATE: F.I.R.M. DATE: 09--20-06 -r
FLOOD ZONE: At. (7') 2700 N. Crootan Hwy. Kil; Devil Hills, NC. 27948
SCALE: 1" = 40' REC. REF. M.B. 3, FG. 112 Phone: (252) 44i-1415 Fax: [phone]
FILE NO.: 16-310 D.B. 1166, PG. 100
DWG NO.: 16310P PIN NO.: AA yn�d�e",I�m-,a bin P or °""ror1O"a�io to is document
is a
209E36714246974
i

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