72831D - Killion

OCAMAJ DREDGE & FILL
GENERAL PERMIT
Xlew ❑Modification ❑Complete Reissue ❑Partial Reissue
No. 72831 A B C
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality '7� /- �O
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /
v ❑ Rules attached.
Applicant Name Terct /� 1 Lz1 ay Project Location: County11
�C�✓ /y��✓Ol���
Address //L-Z FO%C -Y .�7, Street Address/ State Road/ Lot #(s) 7
City Zq&16* State ZIP •2 %!y O�
Phone # (YI-7) XTY-OY6S E-Mail �f , L(�o.� «A•�• 0"' ,
Authorized Agent L, O �`�.✓� '
Affected ❑ Cw #A ❑ ES ❑ PITS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / PNA yes /
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r is Pri ted Name
Signature* P ase read compliance statement on back of permit
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Application Fee(s) Check #
PermitOffic is Printed Name
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S37�t611
Iss ing Date( Expiration Da e

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
11�� tt
Name of Property Owner Requesting Permit:
Mailing Address.
Phone Number:
Email Address:
I certify that I have authorized
422 Forsyth St Raleigh, NC 27609
yy��W
L�� lli�rl'►
Agent! Contractor
to act on my behalf, for the purpose of applying for and obtaining all CA/MA�permits
necessary for the following proposed development: /l ll�� �✓�(h�r"7 f`"J
r YrZz�x, � �7i13%i�l 'deck ���1� l�/�r�n6 �`Y�6' ��in��✓i�l G`'�a��� .
at my property located at 1 i3t_S1tr:cfdK�f< lti�/i�H�3t?"r� � (:
in /YLr�i/yl9'%t'ttr't'-�County. %YD 4,90111 tp) dulJ%!` Q N'�Ndo N
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 rmation:
nature
-! 1 rA
Nnnt or type twame
Wa L-W
TWO
f & 51AW416 &W"4M AV.
P.O. Box 868
Wrightsville Beach, NC 28480
[phone]
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1
RECEIVED
FEB 19 2019
DCM WILMINGTON, NC

V"&%I., — .yq 1- I%-. V.U• .mow Vn —,K- --
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAiVER FORM
i
ame of Property Owner:
idress of Property: �� l%�';�f.:�.�tq r/P• iti;t,;/!,' �c'9 �/. (• p1i'�L�
(Lot or Street #,Street or Road, City 8. County)
lent's Name #: red /i'ttl; Mailing Address:
lent's phone #:
iereby certify that I own property adjacent to the above referenced property. The individual
)plying for this permit has described to me as shown on the attached drawing_the development
ey are proposing. A description or drawing with dimensions, must be provided with this letter.
1;;I. 2_1 have no objections to this proposal. __ _I have objections to this proposal.
/ou have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
•icing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
ilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
.nsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
inderstand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
ick a minimum distance of 15' from my area of riparian access unless waived by me. (If you
!sh to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. —Tke- Ae-W (r." covt+qo� e-+10Y0RC k on
txrrnuda l7rive �yht;�rlle 1&Qc�
I do not wish to waive the 15' setback requirement. 5 Wr
4kan blge ext i d N1q ock oM lNc.
anu Morc.
Owner Infamation) (Adjacent Property Owner Information
Joel George Killion
int or Type Name
422 Forsyth St
3iiing Address
Raleigh, NC 27609
ty/State2ip
917.434.0465
dephone Number
February 18, 2019
115
Signature
Print or
T pe Name
161 S- c4 S ✓61✓ L
a
Mailing Address �"Of
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City/State2ip
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s/9 - o S1
Telephone Number p
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Date ---
Revised &18/2012
)
RECEIVED
,---Fk 19 "'ht�
DCM WILMINGTON, NC

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPER7V OWNER NOTIFICATIONiWAIVER FORM
Name of Property Ownern: /JOL
Address o/ Property / bo-' f :Milt OQ • . PAII M?7 J)/i(f � 1i, lU� (• AYC
�; I/(Lot or Street #, Street or Road, City 6 D �j��/
Agent's Name #: //��C%l1 r!'111d Mailing Address: mi�ll/, d� 1� f3"fI
Agent's phone #: _/%r. 301 �, &I-14013V,19 d%t,VZ4, Nil • MA,
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 aopposing. A description or drawing, with dimensqne, must be provided with this letter.
! ave no objections to this proposal. I have objections to this proposal.
d you have objections to what is being proposed, you must noUty the Division or Coastal Managament (DCM) In
writing within f0 days of receipt of this notice. Correspondence should be malted to f27 C&IM"l Drive E+t ,
Wilmington, NC, 28405-3845. DCAf representatives can also be contsoad at (gig) 798.7215. No response Is
considered the same as no objection N 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
1 back a minimum distance of 15' from my area of riparian access unless waived by me. (if you
\ w`isLl�� to dive the setback, you must Initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property O ner Information)
Signruu�e
PfW or Type
Alaifing Adore
c� /Steta✓L
Telephone Nu r
Paw
. Usr,
( cent Property a or Information) SlVtalur
e SiEn
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UWfina Address t
NI'MMMMEL' I�l +
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Tokwhate Number
Ane
Revised 611012012
owl
DECEIVED
FEB 1 9 M.
DCM WILMINGTON, NC

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Date Rec N d
Data De sited
Check From (Name)
Name of Permlt Holder
Vendor
Check Number
chock
amount
Germit NumberlComments
Receipt or Retund/Rea/lo<afed
Columnl
Columnl Column3
Column/
Columns
Column,
Cdumt7
Cdumn8
Column9
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