74794D - Kersting

�. .CAMA / DREDGE & FILL No. 74794 A B C
CENERAL PERMIT Previous permit#
lew :-]Modification El Complete Reissue El Partial Reissue 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 15A NCAC
M �C'� Q t✓i f � ❑ Rules attached.
Applicant Name S Project Location: Countyiv�i_�.
Address V VV AA e' �' 1' 'r�`�' Street Address/ State Road/ Lot #(s)
City �(`�V� IM State�ZIP2"`1 If (� artnr1�td�^C
Phone #110—h �a—� (� E Mail r &-4
division
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Authorized Agent Ci UA/W ZIP
Affected ❑ CW i)6EW XPTA ❑ ES _ ❑ PTS Phone # ( �^ River Basin UV •
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body
nat man_Junkn)
❑ PWS:
ORW: es PNA 5J Closest Maj. Wtr. Body r
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A�enj- r Appl' rin d Name
Sign ure Please read compliance statement on back of permit **�
Zoo
Application Fee(s) Check #
P mitOfficer's P 'nted Name
nature
!z. Ilk
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: t"lEG!{ (.. Le &Lir- 4*
Mailing Address:
Phone Number:
Email Address:
6ff 17
tL-IA
lG
;taf le ,
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: ce h, , 1 d ri C - k
C�P� 1VLy eQ L4 H,,) �'\ �C•li��F �C;�Zv�C �
at my property located at VV C� i Ht-i 0t�4 ,
in JCounty.
/ furthermore certify that I 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 Infor ation:
A J/�
Signature
«8,�C.r lui'(I i. 4
Print or Type Name
Title
10 / (0
Date
This certification is valid through L94_lZa / 20

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER 'NOTIFICATIONIWAIVER FORM
Name of Property Owner: itJ
Address of Property: �7� cj 4Yv1aYi 5 PY011 i
(Lot or Street #, Street or Road, City & County)
Agent's Name #: T)a n; eI Cl S Mailing Address: J3 o Deer4,_ l d
Agent's phone #: __ q I p 3G, bX (27, HA„ %D &+,e d NL 2 P-P'f-3
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.
1 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. Correspondence should be mailed to 127 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 Certified 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.
(Prop J)fy O�rvn9lr Information)
Si lure
Print or Type Name
�a7 6. I 6'Okle
Mailing Address
G 8
CItylStateyZgJ
(q 10)
640 - ,25q I I
Telephone Number
Date
cent Property Owner Information)
Iiinature
fiehec
Print or Type Name
Q a g C",��o,
Mailing Address
cz C, C�L-/ �)c
Cd)gStat p
ri V l 1 I `t
Telephone Number
iI1�?-� )19
Dxe
Revised 6/18/2012

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT �d
I hereby certify that I own property adjacent to J sr�&
N m of PropertV Owner)
property located at J-TC-;;gVw^MS
on t✓4I'II.L.mS4ll N�j�,, (Address, Lot, ock, Roa ,etc.
in C N.C.
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
11Z 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)
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) (Adjacent Property Owner Information)
S' ture
P �nt or y Name Print or Type !me
ailip Ad es Mailing Address -tun C f f
`-t
Cityt` 0 �O f City/St e/Zip
Telephone l umber Telephone N tuber
0 o 1IC" - v0
Date Date
(Revised 611812012)

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Date Received
Date Dapoaitad
CMck Fmm
Name of PW w Holder
Vendor
Ch-* M-bW
chwk
anaaaH
Pe It NumbeNCommenb
Receipt or Refund/Redlocated
Columnl
Co1umn2
cak-3
coh-4
Column6
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Coiumn9
12/17/20191
12/17/2019
Land to Sea Construction, LLC
Michael & Pam Kerstiny
First Citizens Bank
Safe Federal Credit Union
134
$ 2D0.00
GP 974794D
GP $74813D
JD rct. 9445
Tmac rct. 9094
JD rcL 8546
IPA net. 8521
John D. Fountain, Jr.
same
126
$ 2D0.00
12/17/20191
Allied Marine Contractors LLC
William & Rebecca Rain
First Citizens Bank
7991
S 200.00
GP /74628D
GP #74295D
12/17/20191
IF and S Marine Contractors Inc.
Adam Derbyshire
PNC Bank
1 8227
S 400.00