74216D - Bailey

CAMA / REDGE & FILL
r��qmFENERAL
Q ` - ,\P� No. 74216 A B C
PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality -1 , rL .'
and the Coastal Re s Commission in an area of environmental concern pursuant to I SA NCAC y
❑l Rules attached.
Applicant Name ` %V\ WJ Uzj 11 Y )IYC. Project Location: County
Address
City=;�4
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zip� � (-C Ll
Phone # (fEV:]VLJ__ U'-kl `l E-Mail
Authorized Agent Ov&OA U_v
Affected ❑ CW ) )< A MS ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes,/'no,` PNA (yes9no
Street Address/ State Road/ Lot #(s)
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Sub ' ision
CiTYA zip
Phone # ( ) River Basin
Adj. Wtr. Body PIA (nat unkn
Closest Maj. Wtr. Body
Type of Project/ Activity
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A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special conditions
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Agent or Applicant Pjinted e f
Y 1
Signature "Pie r d compliance tement on back of permit��
Application Fee(s) Check #
❑ Seel note on back regarding River Basin rules.
0
Date

hltaJk!'tK _
North Cana Oeputne tt of Environment and Natural Resources
Olvision of Coastal klattagemant
Wd" F 66�-f, Gamnor .kmes K Gropm D(redor HfLp G Ras, Jr- Secrefnri
Authorized Agent Consent Agreement
4CSth RC\l ,f` r is homby auMarized Z act un my bahWF
{P or yen+)
In order to ai)tain any IIA permi(s) Lnred for the Property Nsted he{cra. The autFwd?a6an is Rmited to the
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specific scivdies desatbed in the attached sketch.
LOCATION Of PROJECT:
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PROPERTY OWNER MAILING AAORF_SS:
AUTHORIZED AGENT MAILING ADDRESS�
i 1! ' a 1 M.11,(!Lr iQL—f-v-vIr—
it
PHONEN0.41Q-4S -st�zz
Signatt" of Property owrler_
SignaWre of Authortzed Agent
Date: l `f
177 C�rinBr tkiro Exl, Vi�mingloe, Hadlt f�nolina 2tlt063815
Pure: 51P7987Z15tFAK Qi+)59539B�1famneC �t
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N.ma of Wivi" Appfyioi gor pomtt,k C�
Add= of Froperry
fLot or Streit is,
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or RmM
LIU P % u A'$ i Jf c
: Cfry And Cowes i
nemby cir* that 1 owes pro MW odjasm to the abovemlbmcea property. Tht individwh
applying tc this pew* her dmtcti W to me a shown on dm saubw dmwiag the derrioMrwic�he�,
are proposing. A dawivtlast or drawing, with dimmulont should bt rro%.lded with his ll ee
have W objecdon3 to m+s propost;
it' you have abjactions to what is baWl prepvted, pious• write trio D'•'„ire of C0400L
h+tsaofaa»at, U7 Cirftal Driw J&W4jM Wilmington, NC 18405 or r:i�I 91� -?%•7ziS
witbia Id days of rspiaRof tills,aches. No respaan is considered the some *$ no Qttlectionif
you huve been notified by Certitled Msfl.
wAIR SECTION
i understand that a pler, dock* wering pimp, braakwetar, oaa c muse or bog t t i ft set
bck a r»inimum disuncs or is, from my etees of riparian occau . unrtss,raiv od b-, ns«. tltyeu
% isb to waivt the setback, you must ittlriol tit* @pproprioce blank Wow
do wish to waive the 1 J' Wback recOrt^"--.
i �g�j a ash to �vaivo rhu ! Ssetboest-eo:�e T :� :
aG✓'t d'T
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?riot Name,......�.._..._.w,.._.....�...,._.,._�.......,.....
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Telopbo w Nvrj at witb

Nerve of Individual Appiyia j For Pomit:
A, tm of Propem,
ecl-s+ N)o,ch-� d C I
or Strw
;Ctty and County}
Hereby cattify that i owe property admit to the above.reftrencec ro
aPPIYing tot this p has desaiw to eat as 04wn on thesaac�rc drawing m 'The MdiY 9"
are proposing. A deseriadan or drm+vin& with dimemlonL should tc cr0*.,ide,4 wfth tMs hoer
have no ob*doag to tmis P say
It' }rou have objections to what is bfla# propos+►d, Ofase wrire Me D,►t,►-,n of C+aerrb..
h^tsaa911a8as, U7 C"dianl Drivs 89006I ik Wilmington, NC 28445 or c:j1j 91� 79j•7115
wirbio 10 days of reeaiprortitb Roo#& No retpoRse is eoRoidered the same as no ob;wtonif
�ou have been norifled by Ctrtifled Mail.
W A►MR SECTION,
i u4der1t0Q4 thatII plot,doeit, mraoriMPUh4s,bmkwetar'. *cc c:iquso or Dan: lift thltltbeset
bck a minimum distance of is, from my or" of riparian access « unless waived b% rna of yeij
wish to waive the setback, you mutt initioi the agFropriote blank below
<> do wish to waive the t $' setback reoctre—:
¢Q.Q,QI A ish to ,veive the 15. setboett Leo;
►tn Nlessc ,ate
c
?Hilt Name
Odd Telophow Mimba with Arai soon D NR

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Data R--ved
D—Deposited Check From Name
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit Numb —Comm M
Recei t or Refund/Reallocated
Column,
Column2 Co1umn3
Colum.
Columns
Column6
Column?
Column9
Column9
0/102019
A-- Marine n I-
J,m 8,0e A—abon
1 C e nk
86605
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