74565D - Golden

4CAMA / _ J DREDGE & FILL NO. 74565 A B C
GENERAL PERMIT Previous permit#
ew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As au orized by the State of North Carolina, Department of Environmental Quality O /� /
and the Coastal Resources Commission in an area of en ironmental concern pursuant to 15A NCAC '
r /ules ttached.
Applicant Name I �M '� I f V1 Project Location: County
Address•• f70 u C T'- cr• Street Address/ State Road, t # s
City !/V (, iM State L ZIP 20yy(/ Af
Phone # Q) f'i Subdivision
Authorized Agent-) ' ►Ay No% )1rv, (� 0 f (N 1
ity /r (� iM !��/ VA) ZIP Zr�//
Affected El�� Cw ' PTA ❑ ES ❑ FITS �(�" Phone # ( River Basin (v"
AEC(s): ❑ OEA 1-1HHF ElIH El USA El N/A v i I^r` Adj. Wtr. Body n an unkn
❑ PWS:
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Agent or Applicant Printed Name
Signature *'� Please read compliance statement on back of permit *
Application Fee(s) Check #
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P i Officer's Printed Name
n ure
� 12A • /' Iz .26 /4F
Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ✓ ,,'I
Mailing Address: g "7Q o Qa 11
Phone Number: °� �� " �� ��` q-_2
Email Address: Ojeng w�-'aAv►SOY_S- corms
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: d C* e__k
at my property located at `6`70 D '-p., t I Ea S } e 6
in Wevi Po v)o vex 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:
Signature
_F�r "n tC- G-0 1 Ie in
Print or Type Name
Title
9-- 1 l2 1 20 I
Date
This certification is valid through

CERTIFIED MAiL • RETURR RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
Name of Property Owner: Pz- (5,=� 10�1 ^J
Address of Property: $ boo ` Q / Z7�, / l _ a,
(Lot or Street #, Street or Road, City & County)
Agent's Name #: ���1,., �� Mailing Address: i�, 3 l q J j; Ws U i!/, �
Agent's phone #: 21 n - a 3 L :' 5f L/ C � �? ,V o
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.
V 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 Divislon of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to f 27 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 Certifled 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 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sign u
f`-jf�
Print or Type Na
Mailing Address
City/StatelZip
Telephone Number
jTe tn`\\t Pr pe Owner Information)
1 I
Signature
n ii-,1 ' �4) r-��
Print or Type Wme
Mailing Address
City/StatelZip
910 boo- 3L1S
Telephone Number
l s
Dare Date -
Revised 611812012

oil
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name* I r; f �1 Mailing Address: /-3 /1/ Z,
Agent's phone #: /�? oZ - S / e a1/0 -S
I .hereby certify hat I own property adjacent to the above referenced property. The individual
applying for t . permit has described to me as shown on the attached drawing the development
they are pr osing. A description or drawing with h dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
1f you have objections to what /s being proposed, you must notify the Division of Coastal Management (DCM) !n
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Exit,
witmington, NC, 28405-3845. DCM representatives can also be contactedat [phone]. No response is
considered the same as no ob1ection if you have been notified by CertifledMaH.
WAIVER SECTION
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 Wow.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope_ Owner Information)
Si r
Print o Tr Print Names
Mailing Address
C"tate p
/0 -:z3/
Telephone Number
Date
(Adjacent Property Owner Information)
/.t a C . 37Z9
Signature
50-v-0, C."
Print or Type Name
%i�l F,al� �- Lt
Mailing Address
City/statelzip
Telephone Number
Am�
Date
Revised 6/1 &?012

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Date Received
Date De osited
Check From Name
Name of Pwmif Holder
Vendor
Check Number
Check
amount
Pemrit Numbw/Comments
Receipt or Relund/Reallocated
Columnl
Column2
Co/umn3
Colu-4
Columns
Column0
Column?
COW-8
Cakwe
9/9/2019
9/9/2019
_
Stal Marl
9/10/2019 Valene and Michael Pflum
9/10/2019 Kyle Mitchell
Michael Pflum
Kyle Mitchell
Sunset Lakes HOA
Sunset Lakes HOA
PNC Bank
Wells Fargo Bank
BB&T
First Bank
3398
$ 200.00
GP #74585D
GP #74595D
JD rct. 8748
1615
$ 200.00
JD rct. 8561
9/9/2019 9/10/2019
9/9/2019 9/10/2019
9/9/2019 9/10/2019
Dean G Siler 1 of _
2�
Siler's 2 of 2
5185
$ 400.00
GP #72311D
TMc rct. 9147
1184
$ 200.00
GP #72311D _
TMc rct. 9145
TRA COM Services
_ _
Earl Deese
_ _
BUT
6211
200.00
GP #745310
ITMcrct. 9143