Dickson, Walter

JCAMA / 1 DREDGE & FILL No. 75790 A B C ! D
GENERAL PERMIT Previous permit#
JNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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
f `[Rules attached.
Applicant Name t1\�'�{{ �i F"") Project Location: County t
Address I . ( T C.-ti C -1 Street Address/ State Road/ Lot #(s)
Phone #
Authorized Agent
Affected NCW NEW El PTA XS ❑PTS
A
Affecte N OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
q PWS:
ORW: yes,/) no PNA yes / no
Type of Project/ Activity
Pier
Fixed
Float!
Finge
Groin
Bulkh
Basin,
Boat
Boat
Beac
Othe
Sher
SAV:
Mora
Phot
Waiv
A bui
( Note Local Planning jurisdiction)
Notes/ Special Conditions _
Subdivislo
City _ ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat- man /unkn)
Closest Maj. Wtr. Body
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Agent or
Sign ture ." Please reatd compliance statement on back of permit" Signal re
Application Fee(s) Check # Issuing Da e % Exp ration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1'. 1al k f Di cy WY)
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �1 l �&)Cad
at my property located at
in 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:
Print or Type Name
Title
),ply
Date
This certification is valid through / I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 1i2 lam' � � IV U Ca f✓I � c6m
Address of Property: j IBamr, +�,� q- - i\ 1 xpsa(1
(Lot or Street #, Street or Road, City & County)
Agent's Name #: 3o`5 ) I aCh Mailing Address:
Agent's phone#: qto'S3p"55Lo D� I GieCAClit
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
availableathttp•//www.nccoastalmanagement.net/web/cm/staff-listingorbycalling 1-888.4RCOAST.
No response is considered the same as no objection if you have been notified bar 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.
ropt y "Info on) y
(/Signature
Print or Type Name
111 '� '30-. m
Mailing Address
City/State/Zip
910-- 548- gg12
Telephone Number/Email Address
Ia-I�)In
Date
(Riparian Property Owner Information)
Signature
A45,PW ty t4)#411r11x1?S
Print or Type Name
;Z./3 Vic TD/Q cT
Mailing Address
660VA/6/f , Nt; 975-a7
City/State2ip
117- M'6 - yjyo /,EWRa�23( Aot. Gorn
Telephone Number/EmaiPAddress
IZ31"
Date I
(Revised Aug. 2014)

■ Complete Items 1, 2, and 3. A. signature
■ Print your name and address on the reverse X El Agent
so that we can return the card to you. Addressee
■ Attach this card to the back of the mailpiece, B. Race v by Ante 91 C. Bate of Delivery
or on the front if space permits.
1. Article Addressed to: -- - D. lad iveryaddr dill • t from ftem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
S 83�' /Y�nrnres��r`
PA) e'115� , ,A/C 9� 7009
3. Service Type
❑ Priority
❑ Adult Signature
III IIIIII IIII III I I I I II I I III II II IIII IIII IIII III
❑ Registerd Mail-
❑ Adult Restr(ctd Delivery
❑ R eglst nd MailPRestrlctd
edSignature
11 Cenifid Mail®
Delivery
9590 9403 0208 5148 1431 06 ❑ Certifid Mail Restricted Delivery
❑Return Receipt for
❑ CPllect on Delivery
Merehantlise
❑ Collect on Delivery Restricted Delivery B Signature Confirmatlonw
7018 0040 0000 8680 6950 ti
B Signature g�
Restricted Delivery
RestrictedDelvery
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Tracking Number: 70180040000086806967
Status
Your Item was delivered at 1:10 pm on December 5, 2019 G Delivered
in JACKSONVILLE, NC 28540. December 5, 2019 at 1:10 pm
Delivered
JACKSONVILLE, NC 28540
Got Updates \/
Text & Email Updates
Tracking History
Product Information
See Less ^
Postal
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Tracking History
December 5, 2019, 1:10 pm
Delivered
JACKSONVILLE, NO 28540
Your item was delivered at 1:10 pm on December 5, 2019 in JACKSONVILLE, NO 28540.
December 4, 2019, 9:31 am
Available for Pickup
JACKSONVILLE, NO 28541
December 4, 2019, 8:12 am
Arrived at Unit
JACKSONVILLE, NO 28540
December 3, 2019, 7:03 pm
Departed USPS Regional Facility
FAYETTEVILLE NO DISTRIBUTION CENTER ANNEX
December 3, 2019, 8:39 am
Arrived at USPS Regional Facility
FAYETTEVILLE NC DISTRIBUTION CENTER ANNEX
December 3, 2019, 1:40 am
Arrived at USPS Regional Facility
CHARLOTTE NO DISTRIBUTION CENTER
December 2, 2019, 4:00 pm
Departed Post Office
SNEADS FERRY, NO 28460
December 2, 2019, 3:18 pm
USPS in possession of item
SNEADS FERRY, NC 28460

GoMaps
January 2,2020 1:500
0 0.004 0.008 0.016 mI
0 0.005 0.01 0.02 km
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