75511A_NC Nixon Properties, LLC_20200102

-1CAMA / DREDGE & FILL No. 75511 (29
EN ERAL PERMIT '' Previous permit # A U
B C
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit iss5gd
As authorized by the State of North Carolina, Department of Environmental Quality }}J
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Pfkdes attached.
Applicant Name AK Kl X on Project Location: County Ca n /
Address y So In. .! treet Address/ State Road/ Lot #(s ` �� C,
City el-". � .. e- 14 State M� ZIP Ll �3 L/
Phone # (=) 3 3M' 2 i o Y E-Mail
Authorized Agent '3 o U
r�b��
Affected ElCW �W �"�'A ❑ ES ❑ PTS
AEC(s): ElOEA ❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS:
Lc�����
Age�ty Applicant Pri e
ature * Please read compliance statement on back of permit
Application Fee(s) Check #
Subdivision —
City yQ r f1;, f J zIP 2 7 .7
Phone # ( ) — River Basin 04a u, zt11
Adj. Wtr. Body / % Q !! (nat an /unkn)
— _ - — il._ .e ,
Permit0 icer's Printed Name
Signat e /
Issuing Date 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 1) 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/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date C 0 '% 2 v t
Name of Property Owner Applying for Permit:
VIE l LL-fr.EW',- N) i X o r j
�iaiting Address: )j
ME`LnAy Lebti{ot
L.s� ©`�►'�- t 1_ t-36
om, �/y T.—�
I certify that I have authorized (agent) C'T u to cton my
behalf, for the purpose of applying for and obtaining all CAMA Permits sect mty to
install or construct (activity) l L �-
at (my property located at) � �� Iy ty-o o =Sa - �V=Z fxi,-D 2 q9
This certification is valid thru (date) L7 Ee.:. 0 1 0 G1 -2 - 0
WC&6;�� &C 0,�-, 2-0
Property Owner Signature Date

�' t; LIMITED LIABILITY COMPANY ANNUAL REPORT
tazoi7`
NAME OF LIMITED LIABILITY COMPANY: NC Nixon Properties, LLC
SECRETARY OF STATE ID NUMBER: 1735164 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2019
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Mastro, Cynthia Nixon
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
1735164
CA201916300574
6/12/2019 11:45
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
101 Hunters Trail West
101 Hunters Trail West
Elizabeth City, NC 27909 Pasquotank County Elizabeth
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Real estate; rental and sale
, NC 27909
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
101 Hunters Trail West
ELIZABETH CITY, NC 27909
5. PRINCIPAL OFFICE MAILING ADDRESS
101 Hunters Trail West
ELIZABETH CITY, NC 27909
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E. )
NAME: Cynthia Nixon Mastro
TITLE: Manager
ADDRESS:
NAME: William Nixon, IV
TITLE: Manager
ADDRESS:
101 Hunters Trail West 7450 Melody Lane
Elizabeth City, NC 27909 Bloomfield, MI 48301
NAME:
TITLE:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Cynthia Nixon Mastro 6/12/2019
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form
Cynthia Nixon Mastro Manager _
Print or Type Name of Company Official Print or Type Tide of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 2%. 25, Raleigh, NC 27626-0525

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: J1/G 1V I Xah Pr�plll16 L I— C-
Address of Property: I y d2 NI X0h S4rtct W,'hfa //
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address: l Q --7 6y pyS5 &44C
Agent's phone #: 01 C1
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.
-e C, s � S ho \,)
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 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
ner Information) (Adiseent-Property Owner Information)
mirgargirmAs =X
R;('o, E_ —7—e— 1 e—y
Print or T�pe Name
t r 0 jJ t,'orJ St -
Mailing Address
City/State/Zip
CZSSZ� AILo V--
Telephone Number
z/d z//
Date
Signature
Print or Type Alame
J
Mailing Address
TityW1Sta4teipyV
Telephone Number
Date
Revised 611812012

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to NC, ! V ( Ok( 0 tP P-V-�e S l.LQ,'s
/ ` 1 ` I _ ` (Name of Property Owner)
property located at I42-J J i \l�-(n Z-1Y C'x' T
(Project Site: ress, Lot, Block, Road, etc.)
on rah c �C4,- in 1Y\ N.C.
( aterbody)),I_ City/Town and/or County)
Agent's Name #:�Qbb� ���� Mailing Address: (j/weSS a.h
Agent's phone#:��a 33��'0/� I� �� `� ,2"l'�
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 till in description below or attach a site drawing)
SCLr"-e cas �-s
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 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. No
response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
Signature
LPL l l I Q r1� ai 9t i n
Print or Type Name
Oto
Mailing Address
I o0,-YAO- LL NT4Azo i
ity/State/Zip
Telephone Number
(Adjacent Property Owner Information)
Sign fJ
./ riSc ►, I PC k
Print or Type Name
-l3 WA1*x-s S�
Mailing Address
I-td(ovd. NC °ly�l
City/State/Zip
C 110) 1G'I - �O �
Telephone Numb
I �15 0 714
Date
'Valid for one calendar year after signature'
Date"

N iyot"
W4
51x15f DVuLAP
Received
G-L:� 19 2019
DCM-EC
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