74509D - Dillon

%,CAMA / - ! DREDGE & FILL No. 74509
GENERAL PERMIT Previous permit# A B C
New ,Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 I SA NCAC o . \
T t''� —
El Rules attached.
Applicant Name �'C ki 3 Nk,.j c,•-� 7!L) t Lll
Address 45 Nc-t► U"i t ikvE
City , V %AyTE nLA . N S —State _NT ZIP 10 Lo o3
Phone # R_�A) H 03 51 S1 E-Mail
Authorized Agent ----
Affected ❑ CW )MW A
AEC(s): ❑ OEA ❑ HHF IH
❑ PWS:
ORW: yes /�j P N A es no
Project Location: County 17..� a ".4 c'.' k r-i4_
Street Address/ State Road/ Lot #(s) 2 iS
W CA►JR,­ AJE
Subdivision
City S J P-+ SF' -1 3C-A c4 ZIP 2�466
❑ ES ❑ PTS Phone # ( ) 5NA-C River Basin L"M jjE &_
❑ UBA ❑ N/A Adj. Wtr. Body A kw "J 62man /unkn)
Closest Maj. Wtr. Body
Mill
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Agent or/Appliaant Printed
Signatu a lease read compliance state m nt on back of per
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Permit 0 i er's Print Nam
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Signature
Check # Issuing Date Expiration Date

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9/16/2019
Mail - Ods02170Cpc - Outlook
US MAIL -�
CERTIFIED ,MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACEirT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: A05 W
(Lot or Street tl, Street or Road, City & County) �� 4 Cq
Mailing Address:Nis./
Applicant's phone a: 114 7 V) h 55
N�,q-1 <--1
1 hereby certify that I own property adjacent to the above referenced property. 1he indtviauai apptying ror tills pernnt
has described to me as shown on the attached drawing the development they are proposing. A description of drawin
with dime ions must be provided with this letter.
'/ u 4 1 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. 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 flail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
1 do wish to waive the IS' set back requirement.
I do not wish to waive the 15' set back requirement -
(Property Owner Inn'formatioo/nn)�)
Signa��t--ure
io
Print or Type Name
Mailing Address
Iv . i, 4P N, )-� NY KX03
City / State / Zip
Telephone Number914 403 59 5J
Date 1 �_
(Ri /ari Proper er Information)
J
Si azure
Print or Type Name
3Gl15
Mailing Address
G e,r,s � �\J L a7 q O S
City / State / Zip
Telephone Number
Date ;l.
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: [phone] FAX: [phone] Intemel: www.rlccoastaimanagement.net
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9/17/2019 Mail - Brock, Brendan O - Outlook
US MAIL
c I_Rl II'llF1AIL R-F-TuRN >Zr(-Elrf RE ul S rr:u
I)IVIS101,4 OR: COASTAL MANAGtNIENT
ADJAUEN`1' RIP��ARIAN PROPERTY OWNFR SI'ATENIENT
Name of Property (?
Uc
Addre:str of Property: p2 �` ot ��5ueet N. Sueet w Road, C' ity Xc C'nunty) �c 4 (�%
155 ailing Address "i� c� , a_ -rn044 .-=—L '
applicant's phone, X' 9 ►� 7 �� MT
I hereby ceriifv that I own property adjncent to the above referenced properly. The individual applying for this permit
has dcsc:nW to me as shown nn the attached drawing, the development they are Proposing A de crintion cf Etta Y.
wi4b-dis.letter.
I have no objections to this proposal. I have objections to this propo►al.
If you have objections to what is being proposed, you trust notify the Division or Coastal Management (DCN![)
in writing ►rithin 10 day:x of receipt of this notice. Correspondence should be mailed to 121 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCNI representatives ran also be contacted at [phone]. No response is
considered the same as no obieedarr if youhave been notified byfCertified plait.
WAIVERSECTION
I iniderstand that a pier, dock, mooring pilings, breakwater, boathouse, or Iifl must be set back a minimum distance of
i 5' from my area of riparian accc.m unless waived by me. (if you wish to waive the setback, you must initial the
apMprmte blank below.)
I do wish to waive the IS' set back requirement.
I do not wish to ►vaivc the 15' set back requirement.
(Property Owner
,Inn�funrnation)
Signature
�{Pr�in�t or Type Name
Nrkcrrry->11t � j�-
Mailing Address
City / State / ?..ip
'relcphone Number�p 1___4 4p3 59 5-�
Uate _�
Print or Type Nwne;
Mttiling
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Telephone N:tmb c�:
Date
127 Cardinal Olive Ext., W-lr:tingtutt, North Carolina 28405-3945
Plane: 910-796.71151 FAX; 910-395-39641 Intemet• V• vw.nrzoastalra agernent.net
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Tracking Number. 7018 0360 0001 3614 5054
This item was delivered on 10/03/2019 at 13:35:00
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I
Signature
Address
435 SHORE
SUNSET BE.
28468
ORW
NC
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Date Received
Date Deposited Check From (Name)
Name of Permit Holder
Vendor
Check Number
Check
amounf
Permit NumberlComments
Receipt or Refund/Reallocated
Column?
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10/18/2019 1 Muddy Waters Marine/David Grice
_ _
I Ken and Nancy Dillon USPS MO 2.53E+10 $ 200.00 GP 74509D BB rct. 9113D
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