72325D - Chadwick

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-/LAMA / DREDGE & FILL
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N2 72325 A B C I@
GENERALPERMIT
Previous permit#
w -Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality hh f�'�
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and the Coastal Resources Commission in an area of environmental concern pursuant
to I SA NCAC (T(�
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Applicant Name _r�1'1 $► QS hq ()NJ
El Rules attached.
Project Location: County 9wsw' C V_
Address 30 Towle► Creek Id
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Street Address/ State Road/ Lot #(s) LCC&"XCJ
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City ►-eland State NGZIP 99�1'
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Phone (Vo ) ,Aa o4 E-Mail fVMff) Y4A
Subdivision
Authorized Agent ��/ �(a SS
City /; ✓/a ZIP 84�
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❑ Cw SKWIS}'PTA ❑ ES ❑ PTS
Phone # ( ) River Basin LGYL%/I
Affected
AEC(s): ❑ OEA ElHHF ❑ IH ❑ USA ❑ N/A
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Adj. Wtr. Body w nat unkn
❑ PWS:
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GO[IG�L�j SFC c� 'el
ORW: yes / no PNA yes /�
Closest Maj. Wtr. Body If
Type of Project/ Activity
Pier (dock) length FV CX,AJ;!M uiA
Fixed Platform(s) 12r16
Floating Platform(s) X
Finger pier(s)
Groin length
number
Bulkhead/ Riprap�ll
avg distance
max distance
Basin, channel
cubic yards
Boat ramp
1
i�4
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Boathouse/ oatli 1� -x
Beach Bulldozing
Other 1
Inc K 0. 14 f�
Shoreline Lengthy' IVV
SAV: not sure yes °Q
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes no
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A building permit may be required by:
( Note Local Planning jurisdiction _�
Notes/ Special Conditions Jn} �/�/
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Agent or Ap licant Printed Name
Signature ** Please read compliance statement on back of permit
J 2 5 a io /h )
Ap�lication Fee(s) Check #
(Scale:
0
❑ See note on back regarding River Basin rules.
7q�/C fMt,�n
Permit
P 'nted a�
Signature
Issue
S a e Expiration Date

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Tom & Mesha Chadwick
Mailing Address: 349 Town Creek Rd. NE
Leland, NC 28451-7373
Phone Number:
Email Address: [e-mail]
I certify that I have authorized Joel Klass
Agent! Contractor
:o act on my behalf, for the purpose of applying for and obtaining all CAMA permits
-iecessary for the following proposed development: Installing 8'X12' deck, 4'X4' stoop,
XX16' alum ramp, 8'X16floating dock, & 13,000 lb boat lift
at my property located at 539 Lockwood Follv Rd.
in Brunswick County.
furthermore certifv that I am authorized to grant, and do in fact grant permission to
Jivision 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.
Prop e bwner Information:
Signature,
1 ylDiha� �
Print or Type Name
Title
�lP"? lC�01_3
Date
This certification is valid through 111

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Tom & Mesha Chadwick s
property located at 539 Lockwood Folly Rd. (Name of Property Owner)
on ICW (Address, Lot, Block, Road, etc.)
, in Brunswick N.C.
(Waterbody) (CityrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
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I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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-
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Tom & Mesha Chadwick
Print or Type Name
349 Town Creek Rd. NE
Mailing Address
Leland, NC 28451-7373
City/State2ip
Telephone Number/email address
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*Valid for one calendar year after signature*
(Adjacent
Information)
Wgnatfire *
Joseph B. Taylor ET Dia a K.
Print or Type Name
531 Lockwood Folly Rd. SE
Mailing Address
Bolivia, NC 28422p+
Tele�hottJe`` Number/ ematl address
Date *
(Revised Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Tom & Mesha Chadwick
Address of Property: 5�9 Lockwood Folly Rd. Bolivia, Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass
Agent's phone #: [phone]
Mailing Address: PO Box 279
Supply, NC 28462
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.
KffI have no objections to this proposal. 1 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 notices Contact information for DCM offices is
available at htto:/lvr,rv✓.nccoastalmanagement.net/y✓eb/cm/sta;f-listing or by calling 1-888-4RCOAST.
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, 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.)
f :9 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Tom & Mesha Chadwick
Print or Type Name
349 Town Creek Rd. NE
Mailing Address
Leland, NC 28451-7373
City/State/Zip
Telephone Number/ Email Address
Date
(Riparian Property Owner Information)
Signature
Kim Ray Todd
Print or Type Name
1643 Walter Todd Rd.
Mailing Address
Clarendon, NC 28432
City/State/Zip
Telephone Number/Email Address
Date
(Revised Aug_ 2014)

D.ft
Uete Re dgvod
Deposited Check From(Nam)
Name of Permlt Holder
Vendor
Check Number
Check emounf
Permit NumbwlCommentn
Receipt or Refun&Ra11—fed
Colum f
Column2 Column3
Columol
Columns
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Colume7
Columnd
colwW9
1/2/2019 Joel Klass Tom & Mesha Chadwick USPSOrder 25128799503�
_200.00 GP 972325D PA ret. 7334D
1/7/2019 Rick West Michael & Kimbell Moore BB&T 5352
200.00 GP #54528D TM ret. 7313D
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