72789D - Daniel

-<CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
�*ew --Modification El Complete Reissue ❑ Partial 6issue
No. 72789 A B C
Previous permit #
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 1 2-y c�
❑ Rules attached.
Applicant Name Rc, l?E QT -DA Iq 1 E- L
Address 2- 2. 1 A c, 51419 C Oy1i:
CityGar-w- ISBoaO State N - ZIP 27455
Phone # (-IV 337- 3780 E-Mail A/1A
Authorized Agent R t c HA a oSo iv COWTTR,r c -r t o A/
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[7*TA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / Q°
PNA
yes /
0
Project Location: County -F1RuA/S'w1CK
Street Address/ State Road/ Lot #(s) 3 Z Z
MAPKeFR= T-7IF-Ty FIVE_ 17Rtvg
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Agent or -Applicant P ' ame
Signature ** Please read compliance statement on back of permit
$zoo # 34S
Application Fee(s) Check #
►`/LFR Mc ulstE
Permit Officer's Printed Name
/qc
Signature
1; 7—/20 12o1 9 G�2r) /2019
Issuing Date Expiration Cfate

Jan 291908A5e p.3
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North Carolina Department of En*mment and Natural Resources
Division of.CtfasW Mwugwwt
Beverly Eaves Perdue Jam K Ciegson Ose Finarnan
Gowrstior tlin?Cbr Secretary
AGENT AUTHORIZATION FORM
Date: 1-22-19
Name of Property Owner Applying €or Permit Name of Authorized Agent for this project:
Robert Daniel Will Richardson
Owner's MaMing Address:
22 Flagship Cove
Greensboro NC 27455
Agent's Mairing Address:
3235 Seecrerst Ave. SW
Supply NC 28462
Phone Number {336) 337-3780 . Phone Number ( 910) 367-0335
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtain g all CAMA Permits necessary to install or ccnstnxx the fc0ovving (activity)
Modification to existing docking facility
(my property iocate) at 322 Marker Fifty Five Holden Beach NC 28462
This certification is valid thru (date) 2-19
Property Owner Signature Daft
127 Ca+d rai Drive Ext, YYknngbn, NC 2895
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DITY- MON OF CO_A.ST:4L KkN-AGZ1VfENT
ADJACENT RIPARIALN PROPERTY OWNER STAMNIENT
I hureby c:.rt ,_ that i own property adjacent to RobertDaniel Is
property located at 322 Marker Fifty Five (Name of Property Owner)
on ICW (Lot, Block, Road, etc-)
Holden Beach N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: [phone] Mailiug Address: 22 Fi2►osh' Cove
Greensboro, NC 2
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPIMINT:
(Individual proposing development must frH in description below or attack a site drawing)
Construction of covered area over existing dock. (Please see attached drawing.)
If you have objections to what is being proposed, you must notify the Division of Coastal'M*nagemeat (DC d) in writing
within 10 days of receipt of this notice. Correspondence should be mailed to 1-7 Cardinal Drtve Ext Wilmington, NC
DCM representatives can also be contacted at [phone].
P?Q resDouse 4 considered the same as no obiedion_if you have been ngUed bT Certii;ed Mail
(Property Owner Information)
61,)tGG Authorized Agent
Signabze -- -_
Will Richardson
Print or Type Name
3235 Seacrest Ave SW
Mailing Address __
Sup l j NC 28462
City / State /Zip
Telephone Number 910-367-0335
(Riparian Property Owner Information)
Sigp&6e;
TBCW Properties, LLC
Print or Type Name
3205 Chancellor Lane
Mailing Address
Monroe, NC 28110
City 1 State / Zip �—
Telephone Number 704-289-8090
Date Date Q�
127 Cardinal Drive EA, Wilmington, Noitti Carolina 2840"&
Phone: [phone] FAX [phone] Intemet: www.necoastalmanagement.nat
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Data Received
Date DeposHodCheck From (Name
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit NumberlComments
Receipt or Refund/Reallocated
Columnl
Column2
Column3
C....Columns
Column6
Cclumn7
Col-8
Column9
2r2l t2019
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