74279D - Colonel

CAMA / DREDGE & FILL No. 74279 A B C
GENERAL PERMIT Previous permit#
Jew i✓Modification El 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 I SA NCAC 0 V !
❑ Rules attached..�� ��
Applicant Name jjy /�� �) D hQ_' Project Location: County"l�/�._..
State�kL ZIP ��
Authorized Agent
Affected ❑ CW "" )kTA �RtS ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
~ 0AW: yes / no) PNA yeses%no
Street Address/ State Road/ Lot #(s)
Subdivision f ,
City I O ZIP Or U/
Phone # ( ) RiverCr)Basin
Adj. Wtr. Body An' N (nt /I an nkn)
Closest Maj. Wtr. Body IPA w VV
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OWN
Agent or Applicant Printed Name
Signature* Pleas read compliance statement on back of permit **
Application Fee(s) Check #

■ 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 fro the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
s�Ve- N
,,1-70/ 5-:'
111 IN I I111111111111111111111
9590 9402 4439 8248 2443 58
2. Article Number (Transfer from
7019 0140 0000 4740 6838
PS Fop,3811 , July 2015 MN 7530-M-MWgM
B. Recelved by
['Anti
❑ Addressee','
Date of Delivery of vi�eryery ,
v / - - r v/r
Is delivery address di erent from item 1? 0 Yes
H YES, enter deliveryaddress below. Q-{
3. Service Type
❑ Adult Signature
❑ priority Mail Express®
Expr
El Adult Signature Restricted Delivery
❑ Certified Mall®
❑ Registered aJITM
El
El DReVsterad Mall Restricted
❑ Certified Mail Restricted Delivery
❑ Return eceipt for
O Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery ❑ Signature Confimyrtion-
❑ Insured Mail
❑ Signature Confirmation
f Mail Restricted Delivery
Restricted Delivery
5001
Domestic Return Receipt

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: # `A a--n N
Date: W ((� I
Describe bellow they I41AIJITAT disturbances for the application.
.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
im act amount
temp im acts
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill Both ❑ Other ❑
a�
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
-INName of Property Owner: _ '�"� v e l�\!C-
Address of Property: J U V", C � f
r
(Lot or Street #, Street or Road, City & County)
5 10 n
Agent's Name #: & a 6 �^OU! 4' Mailing Address: q4 ix i '' Cr
Agent's phone#: ��� ���I_v),� (UC,
b
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,mustbe 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
waiting 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 [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 ado not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature �c
hne�
Print or Type Name
'Z Kg � GO�-
Mailing Address
,clir,C4On N0 n,Ztj
City/State/Zip J
(�31:,� 4g4- � qW,
Telephone Number
.mate
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
RECEIVED
Telephone Number V tt 3 i r' "I
Date
[)CM WILMINGTON, NC
Revised 611812012

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: %/h a r4a l' 1'� 40 c� C(c dc-c- Ni CD(Cne/
Mailing Address:
fk6oJ
(10W ss
Phone Number:
Email Address:
-)-8o(--O rct te U r r3k t (t no r� �%�-7 2
47C Ire Y� D r OQ �'S (4nc Mt_�- 76Sf
-3d-4?sz/-Y4,41/1
I certify that I have authorized C 6\, v t -� L-v (/�Z! ,
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 4� 1( A 4 fhg4
at my property located at ,Z70 74-c f �r� oak n L,*n Z
i
in (-L" n 5(A✓(ckcounty.
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
/'A"Z
Print or Type Name
42 &) &,r—
Title
d Dsf'
Date
This certification is valid through / /
RECEIVED
DCM WILMINGTON, NC
MAY 13 2019

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SCALE NO . Prk'EC1S-
Waienjay
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PLAT OF SURVEY FOR
0Mrs.?�o,rc� Co or, e_
NTl� ^dl
SMITNVILLP- TOY
OAK SSLNNG
p 30
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'; BRUNSWICK COUNTY
NORTH CAROLINA
60' 90,
6ECEIVED
4 4 DCM �ILMINGTON, I
scx I 42 — -
53 MAY 1 3 2019
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NCDENR
North Carolina Department of Environment and
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Natural Resources
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date: a Zv !
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
1 0 r^0i5 �f on &/ c
Owner's /Mailing Address:
%O Zra
;L75-1-15
Phone Number (3 � b 63-6 y Z-/ qX
Agent's Mailing Address:
cAc
Phone Number&/O
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install,or construct the following (activity):
For my property located at ,�A70T
This certification is valid thru (date)
lwmw�M—Mof ���
Property Owner Signature
3� y
Date
127 Cardinal Drive Ext., Wilmington. NC 28405
Phone: [phone] FAX: [phone] Internet: www riccoastalmanagement.net
5
RECEIVED
MAY 3 1 2019
DCM WILMINGTON, NC
NorthCarolina
Natimally
An Fnrral ikmnrfunilv'. AKrmativA AMinn F—J—

CER`fIFIEQIUAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MAMAOEMENT .
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICATtONfWArVER FORM
Atf
Name of Property Owner:�y
Address of Property: ���. �� �,CL �1r• __ - T,
sty & County)
s •
Agent's Name #�� �.C�V=-Mailing Address: 4L'1'
Agents phone #: _ cj �� ' rhta � `� f �i i A x � ,
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_descriotion or drawing. with dimensions,mustbe provided with this letter_
__Z have no objections to this proposal. I have objections to this proposal.
� P P
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 clays of receipt of this notice. Correspondence should f marled to 127 Cardinal Drive Fact,
Wilmington, NC, 28405--3845, DCM representatives can also he contacted at [phone]. Mo response is
considered the same as no objection if you have been noittied hY Certified Mail.
ittlAfVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimums 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.
1 do not wish to waive the 15' setback requirement.
(Propert)r 0%,vne7 Information)
Signature
--� b
10.
Print or Type Name
Mailing Address
(�t& (-�Ir,C On ,N0 L?Z_t�
CitylState&ip J
� `a"L-fL - 4
Telephone Number
s��q Zd�
Date
(Adjacent Property Owner information)
C'" o)[0111/Z Y54c/
*nature
s Wtiv J r.
Print or Type Name
Marling Address
City/StatelLp RECEIVED
Telephone Number
&- 12, - I el r)CM WILMINGTON, NG
Dale
Revised 611812012

Date Reeeived
Date Deposited Check From (Name)
Name of Permit Holder
Vendor
Check Number
aCheckmount
Permit Numb —Comments
Receipt or Refund/Reallocated
Columnl
Column2
Column3
Column)
Columns
Co.
Co...
Column8
Ilumn9
6202019
IThamas and Clover Colonel
IThomas Colonel
'American National Bank nd Trust
177
400 DO
GP a74 79D
ITmac rct. 8466