74507D - Harris

Ai 2Commission
& FILL J\6�F`Lp 11 I1gltl (�l �NO. 74507
Rthe
A B C
.ERMIT Previous permit #
New MoComplete Reissue ❑Partial Reissue Date previous permit issued
z by the Statlina, Department of Environmental QualityCZVoas ourcean area of environmental concern pursuant to I SA NCAC
�- ❑ Rules attached.
Applicant Name
f � M � � � i` � Project Location: County_ � ¢ `1 b.) S �+ % c K—
Address 'yy �L�te fho./�'ti-t �� Street Address/ State Road/ Lot #(s)
City N - (�H 1 State ZIP 2'�-(PO3 Ar'� �•
Phone # (1A U0(o 939E-Mail
Subdivision
Authorized Agent ?Z C�- V C.s City--0j G111l' c Op LoAffected -1
❑ Cw Mw A El ES El PTS ArdN Phone # (0) 3 (93 (Ac& LyRiver Basin �✓� QE f2--
AEC(s): ❑ OEA O HHF '❑ IH ❑ USA ❑ N/A Adj. Wtr. Body E,� Srr2 nJ GO QAJCL Iman /unkn
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❑ Pws:
ORW: yes /� PNA yes /
Closest Maj. tr• B _
Type of Project/ Activity —X-T CN D r i,v k f ti V "c-t t_ 4 -t Ty 1 c R.- " t n O A
t_ ,,. (Scale: r Zdt )
Pier OU
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A building permit may lie -A uired by: f�� cAw I sce-- QE fN c-Li ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions LLB 166 w ki t Z t uN -s o f 0- H • \ZA of L o GA c . ST (A-"T C �' (- E 069A 1.
6
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Name
Signat "Please read compliance statement on back of permit"
Applic i n Fee(s) Check #
CA^4h.41- r-tiTC-r- \ PA S'1
Signature
Icy—jS-19 2-15-2-y
Issuing Date `cExpiration Date
QcQ �FiSs+�� ' c,1P,Re-, 31Ial2a

Mail - Brock, Brendan O - Outlook
. _ K-.; 11. N L' Le ; i ; 3'
Name of ProWty Ov"t Reques*lg po,
Maitrrg Adores �Iv)et,
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Phone Nurnber; �1� —6Gi6— Y93� p•- 9� 9 - �`�I - 7
Email Address, ��,ss Ore S •tsto. . re bj
t omb y that I have &&tonzsd (? - Wei r"
Aoarr t Ovriwola.
W aQ on My O.flad, for the purMM of app#Vft for and nil Q ofC""AUA oemrss
rosary tar the foNowr►g orcVasee <fe,rekVffeM 4& yt
.! my properly boated at j 2- �^-. `f ?� S z c /c t3�.,�
f hfrttiertrbre cwtriy tear - am ausrOr 1w o gmfv aed do h fad gnome ps'"US&On rc
Ory WW of CarstW Usnagernant sra.'F the i cc* j WTW pacer and spar &pants to &mar
On V* e/ VffW* n&J Lands -r .:--*Cu— wd" °VID+O'p yW*mmbn reta'e d to tlrtit
penrpt SAONIIWWA.
Propuly Owwer
Pmrt or Type Aosme
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This Gertficabon is valid through 10 r f Y f 2-020
https://outlook.office365.com/mail/inbox/id/AAQkADVjMzg3NTMyLTIIMTMtNGM5Yyl hNzQ4LThiOWM2N WZhNjc5YwAQAKYZsTwNKIBCtrRwgBzXa3... 1 /1

ERTIFI I
• RETU CEIPT ESTED
D MA
DWWWN OF COASTAL MANAGEMENT A710N1WANE R FORM
ADJACEN
T
RIPARtAN PROPERTY OWNER NOTIFIC
5
Name of Property Owner <
7-2
Address of Property. (Lot or Street #, Street or Road, City b County)
Mailing Address. % li
Agent's NaMO V4
�L
Agent's phone
The individual
that 1 own property adjacent to the above referenced attached
dpawi g e development
I hereby certify own on the attached this tt r.
applying for this permit has described or
to me ith dimension m
they are proposing. A
�� 1 have no objections to this proposal. _._._..__ I have objections to this proposal•
pivision of Coastal Management
have obf ectlo W �t is being proposed' you must notify don for OCM offices is
M y rrotice Contact Informs COAST.
(pCAQ in writing within 10 days of ►s"APt .,� �,1cn✓sC'Onlisting or by calling 14W-4R
ncc talman '� notifiod b Call Mail.
avaNaWe at n " J/www' ##, al as no ob ►f have been
WAIVER SECnOW or lift must
ter, dock, mooring pilings, boat ramp, breakwater, boathouse, �. If
I understand that a p area of riparian access unless waived by
be set back a minimum distance of 15 from mY the appropriate blank below.)
yo sh to waive the setback, you
7 MWKklhW i I CIO wish to waive the 15, setback requirement.
I do not wish to waive the 15, setback requirement.
�y Owner Information)
Signature
Print or TvaeName
'7a t �T AtL+i
Mailing Address
City/Statemlp
Telephone Number Email Address
Uate
property Owner Information)
Si re
mil
Print or Type Name
�/S� cS� � 3a `f
Matting address G -2,ice /
City/statelzip
Z7 S- �Z 3 eii it %Oriv �aU. ccJ�s
Telephone Number/Email A ss
9 5, Zo/ 9
Date (Revised Aug. 2014)

EK7 Ir�Gv
RN
RECEIPT P�nt�ESTED
DIVISION OF COASTALNOTIFICATION"
GE-14NTAVER FORM
ADJACENT RIPA UAN V ROPERTY
Name of Properly Owner• Y C-4—
/c% p (0.0 �
�
Address of Property: (Lot or Street #, Street Of Road, City & County)
Mailing Address.
Agent's Name
Agent's phone #.. 2p�
The individual
1 hereby certify that i own prop Y adjacent to the above attached
ddrao� � development
to me as shown on the attached r
applying for this permit has described i i v
they are proposing. A
I have objections to this proposal,V/I have no objections to this proposal• oiCo/IManat
an 0&ftjn
b what is behW propQ�+YOU
is
N yar haw ob/sc o! „ pr os this notice-Cantact infwmation for ckM oa sT.
(DCIM in wrift►W wWdn 10 days 1 of 6y �ii� Mail
ovallableat J .nccoaabl N har�a been r►osW�d
No Is considered t" same as no
WAIVER SECTION or lift must
dock mooring pilings, boat ramp, breakwater, boathouse, If
I understand that a pier, area of riparian access unless waived by
be set back a minimum distance of 15' from my the appropriate blank below.)
you wish to waive the setback, You
MaLk"V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Ipr �,"`Ormaoon)
Signature
%
Pt !(:iir Type o
,s
r- /►h u�- i
Mailing A dress
9i9-�oL-�93
Telephone Number/ Email Address
-T-t--1
Dare
4(RipafiPro Owner information)
�A
prfnt or Type Name
/IF9oq � ,
Mar;ng Address
C;t matwop
Te- 0 Number / Email Address
/zIlig
Date (Revised Aug. 2014)

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• Print
Vtat�we��mm � address on �e fey�e
ff* carcl to YOU
• Attach this cad to the back of the
t. Arnoie space permits.,
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?Ob8 0680 DD01 4660 4733 ww0&Wwum „rror,
PS Font 3811, July 2015 PSN 7530.�_ppp_gDr� D°F'ery
■ Complete items 1, 2, and 3.
■ Pffrrt your name and address on the reverse
so that we can ream the card to you.
■ Attach this card to the back of the mailpleoe,
or on the front H epnoe pan 0
1. Article Addressed to:
-EVS --Pk Y A"^ W C(, S
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If YES, enter delivery addrteee below: 0 No
IIIIIIlI! IIN IIIIIIIII 1111111111111 11111111111 3 Type 0 . ma red mare"°
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9590 9402 4859 9032 1735 88 ❑ C rUW MrA Plesh Die-Y a 2: A.or" for
13 CoW on D90my aaw�ee
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Check
Date Received
Date Deposited Check From (Name)
Name or Permit Holder
Vendor
Clock Number
amount
Permit Number/Comments
_
Receipt or RerundlReallocated
Columnf
Column? Column3
Column4 _
Column5
Columns
Column,
Column8
Column9
10/16/2019
10/16/2019 Legacy Homes Inc Mark Tyndall BB&T
6339 $
100.00 minor fee, 1037 1st St. SC Ons
_
JD rct. 8538D
10/16/2019
10/16/2019 AMW Docks and Marine Construction LLC Tim Harris BB&T
5608 $
200.00 GP 74507D
JD rct. 9117D
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