74348D - Jeffs

ACAMA / ❑ DREDGE & FILL No. 74348 A B C
EN ERAL PERMIT Previous permit #
Lp ew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality l , COnd the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 6-7 . tZ C
J
f-1 Rules attached.
Applicant Name Jr, S�,
Address 1;-1 a &ael
City CkAod AA State_ j J� ZIP r�
Phone # ( 293 -705LE_Mail LAL S 3 V W"^
Authorized Agent M�14
Phone # (11 ) ?9�" (oq10J�re River Basin L'- -. bcr
Adj. Wtr. Body X\ w w na man /unkn)
Closest Maj. Wtr. Body— 'AjWW
Affected ❑ CW KEW ?fTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / 0 PNA yes / nI
Project Location: County 13� _,�v,,,,�►`
Street Address/ State Road/ Lot #(s) S&4
ROA/ LA dy1MG WYAM
Subdivision
City, ZIP % kH(oZ
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NjY ri �„--
Agent or Applicant Printed Name
►
Signature ** Please read compliance statement on back of permit **
Ion ��~ "2121
Application Fee(s) Check #
Permit Officer's Printed Name
Signature
-+ L
Issuing Date Ex iratio Date
ys
NjY ri �„--
Agent or Applicant Printed Name
►
Signature ** Please read compliance statement on back of permit **
Ion ��~ "2121
Application Fee(s) Check #
Permit Officer's Printed Name
Signature
-+ L
Issuing Date Ex iratio Date

PROJECT: 864 Heron Landing Wynd, HB
61'
HS CONSTRUCTION, LLC
JEFFS
846 HERON LANDING WYND Not to scale

CERTIFIED MAIL. - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ��y t s C u1 C— J275
Address of Property: ?�{oy �t�+�c:� ��o rc�t�lc 1,�.�v►�.C��es� �eoG� w �.��5`i�Z
(Lot or Street', Street or Road, ''ity i, County)
Agent's Name #: H5 Construction _ Mailing Address: 2164 Holden Beach Rd.
Agent's phone #: [phone] Supply, NC 28462
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_
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 Division of Coastal Management
(DCM1 in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http:llwww.nccoastalmana4ement.nethve6JcmJsfaff-listing or;by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
i understand that a pier, dock, mooring pilings, boat ramp, 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.)
i do wish to waive the 15' setback requirement.
i do not wish to waive the 15' setback requirement.
(Property Owner information) (Riparian Property Owner Information)
Signature alitSi trip
Print or Type Name -�
S j t CQ- tC-
Mailing Address r
C.�(t).�
CitylState2ip
Telephone Number / Email Address
05 L 31 1aol�
Print or Type Name
Maifing Address
,B r ► s� ZAZ +G 5 n 7
City/5tatelZip
Telephone Number / Email Address
2'7
Date -- —
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner �Y,r t S C ;1cti Jegs
Address of Property: S `ot I r el ct rc�� ��c LJ.Ir�c� . � Cyr aec 1k: G .2o5y L Z
(Lot or Street #, Street or Road, City i County)
Agent's Name #: HS Construction Mailing Address: 2164 Holden Beach Rd_
Agent's phone #: [phone] Supply, NC 28462
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. Adescription or drawing, with dimensions, must be provided with this letter.
IXi 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. Contact information for DCM offices is
availableathttp/Avww.nccoastalmanagement.neUweb/emisiaff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail -
WAIVER SECTION
AN I understand that a pier, dock, moonng pilings, boat ramp, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Prope Owner Information)
In a Ve
Si otrrre tit
� .S{�natrrre
�_ r( e 5` �c bAd
Print or Type Name i5nnt or Type Name
s t LC,(- spa© 44M
Maiing Address Mailing Address
hi U i C -I5 t -7 �V A,) ,.2 7-5 z�r
Cify/Statelzip City/S e/Ztta p
/n : kt sys
Telephone Number / Email Address Telephone Number / Email Address
0S131 jail! (a Zy/'P
Date - s— Dore
(Revised Aug_ 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C5
Mailing Address: �3 ��k �t��C-r �•-�y�n--
Phone Number: xU�t�� F53� 30�(0 �Sar s
Email Address: Q S (f a-o\ , Co v-n
I certify that I have authorized H5 Construction LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at e,)b`-1 kAkff
in S U,�• c-L County.
W
l furthermore certify that / 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:
Signatu - tf
Chf X-Sykn r-._ �4<1
Print or Type Name
Title
S l ,S( l c201
Date
This certification is valid through / /

Date Recalvad
Data De os@ed
Check From Name
Name o/ Permit Holder
Vendor
Check Number
amoCAeckunt
Permit NumberlCommanta
—I t or Refund/Reallocated
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