71779D - Dillon

CAMA / DREDGE & FILL No 71779 A B C
GENERAL PERMIT Previous permit #
INew -Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality / O
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC D7 I
❑ Rules attached.
��t�r/Oli{ Pro
Applicant Name Project Location: County
S-1, lKd .
City tJ/t StateNL- zip 7kggS-
Phone #6/0 7i E-Mail
Authorized Agent
Affected Ll CW XEW ?OITA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ WA
❑ PWS:
ORW: yes OFP) PNA ,,�gV3 no
Type of Project/ Activi
Pier (dock) length
Fixed Platform(s) iU Y 0
Floating PI orm(s)
Finger pier(s
Groin length
number
Bulkhead/ Riprap len h
avg distance offs re
max distance offsh e
Basin, channel
cubic yards
Boat ramp r ,L.•
Boatho4O%Z;;> 10
Beach Bulldozing
Other W "
Shoreline Lengt -
SAV: not sure yes
Moratorium: n/a yes C
Photos: yes o
Waiver Attached: Ag;) no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Applicant
Street Address/ State Road/ Lot #(s)
Subd7AV
'on
City U zip
Phone # River Basin
Adj. Wtr. Body oeA b t014�O Anna /man /unkn)
� 57�0
Closest Maj. Wtr. Body /4��/L S�yAlQ -
f
r )i11 (1TL/ // T Gt/D - ,4o/<f-
(Scale: "It
%o )
❑ See note on back regarding River Basin rules.
Name
Signature "Please read compliance statement on back of rmi **• J
Application Fee(s) Check (Q}#Ll
F, C1
Issuing Date Expiration Date

10120118, 10:23 AM
Adjacent Riparian Property 0... 1 / 1
r
u 1C X
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
? hereby certify that I own property adjacent to Brian Dillion s
property located at 175 Atkinson Rd. (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on the Intercoastal waterway in Surf City N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc . ,..
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)
Installation of an elevator boat lift connected to the currently existing dock.
lax l�� Ch��nS)an
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.)
_Y�do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner 1 If
Signature
Brian Dillion
Print or Type Name
175 Atkinson Road
Mailing Address
Surf City, NC 28445
City/State/Zip
910-547-3012, ::bdi�licr(a'tsn„
Telephone Number / email address
October 19, 2018
1)alr,
(Adjacent Property Owner Informati n)
Rnature *
Deborah A Showalter
Print or Type Name
173 Atkinson Road
Mailing Address
Surf City, NC 28445
City/State/Zip
614-371-1101, [e-mail]
Telephone Number/ email address
/O � - 7� / si
Date*
ILI
aboutblank
Page 1 of 1

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: (_5 K ►) ,` _
Mailing Address:
S - tf 2 Q yY,
Phone Number: °l �' s-V? (L
Ernail Address: -- t✓� �� �'� U a; l c ap &`-,
certify that I have authorized JI k : �-r ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: —30"14
.at my property located at 1 -7 s— A4 : �. ..t ;Q .. �, . F C . . J*"r �-
in County.
I furthermore certify that 1 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:
r
Signature
Print or Type Name
Title
-7 l r� I z� r l�
Date
This certification is valid through

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Brian Dillion s
(Name of Property Owner)
property located at 175 Atkinson Rd.
(Address, Lot, Block, Road, etc.)
on the intercoastal waterway in Surf City . N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
!Xlq
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)
Installation of an elevator boat lift connected to the currently existing dock.
J
6 "a 6 &-eIe, 5), P
WAIVER SECTION
1 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 y u wish to waive the setback, you must initial the appropriate blank below.;
4kido wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owniqr Information)
(Ad-acent PropertyOwner Information)
i�
Signature
Signature
Brian Dillion
Dale Osbourne
Print or Type Name
175 Atkinson Road
Mailing Address
Surf City, NC 28445
City/State/Zip
910-547-3012, wi)dillionPgmail.com
Telephone Number/email address
October 19, 2018
Date — _
'Valid for one calendar year after signature`
Print or Type Name
177 Atkinson Road
Mailing Address
Surf City, NC 28445
City/State/Zip
540-588-0718, [e-mail]
Telephone Number/ email address
Date *
(Revised Aug. 2014)

Dafe Rece/wd
Dat.
D oaltad Check From(Name)_Name
or Permit Holder
Vendor
Check Number
Check amount
Permit Number/Comments
Receipt or Refund/Reallocald
Columnl
COIUM2 Column3
Column)
Columns
Columns
Columrn7
Column8
Column9
1/3/2019 Darrell Ern /Li hthouse Marine Construction Bnan Dillon Coastal Bank & Trust 2485 200.00 'GP #71779D
JD rct. 6964D