74783D - Loftin

`�CAMA / DRrDGE & FILL
GENERAL PERMIT
iMNLw Modification El Complete Reissue El Partial Reissue
No. 74783 A B C
Previous permit #
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 0 T rt ' 0 Q
[[�� r ❑ Rules attached.
Applicant Name /T 1 C\ Lo 1 r� Project Location: County ' k—
Address 2 U-I tA .P , cto w Street Address/ State Road/ Lot #(s) I ('
City S%.J i State_JX_ ZIPP� �1,,� �C� ��. A J -a—
Phone # U-) r�--E-Mail cLd-f- Js%_4 n,fvi,,,Subdivision
Authorized Agent ' [ ��M S City ZIP
Affected ❑ CW — EW ❑ PTA (A�ES CUTS Phone # ( ) River Basin
AEC(s) : ❑ OEA ElHHF ElIH ElUBA ElN/A Adj. Wtr. Bod A\\N yJ
❑ PWS. i %' rr A gat an /unkn)
ORW: yes PNA,,yesf no Closest Maj. Wtr. Body A�w
Type of Project/ Activity
Pier (docO length
Fixed Platforn
Floating Platfc
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg dista
max dist
Basin, channel
cubic yai
Boat ramp _
Boathouse/ B<
Beach Bulldoz
Other
Shoreline Lenj
SAV: ni
Moratorium:
Photos:
Waiver Attach
-
T(
A building permit may be required by:
( Note Local Planning jurisdiction)
! (
Notes/ Special Conditions ►1 1
(Scale: N ' S Y
�(_ .. a- I �_ S c I 17to' c Vt ❑ See note on back regarding River Basin rules.
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Agent or Applicant Printed Name
azure ease read compliance statement onXbk of permit
Applicati nFee(s) Check#
nted
Signature 1
' 2
Issuing 136q Expi tion ate

11/7/2019
Mail - Brock, Brendan O - Outlook
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: r;Z;ffA
Mailing Address: �G( /neAkw Wtm l&,
Phone Number:
Email Address:
I certify that I have authorized , all 7 ol�w s-
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: /hoer h4,4&.4 el
at my property located at 1111 & .Z.i.�cl ALt'& s u4.5' e
in /'' >fSG�/!c'L�' County.
I 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 Information:
- Signata
Print or Type Name
13a I
Date
Title
RECE�vED
IDCM WILM►NGTON' NC
NOV 0 120
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11/7/2019
Mail - Brock, Brendan O - Outlook
■ Complete items 1, 2, and 3.
IN Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the maiipiece,
or on the front if space permits.
t. Articl6AddressedG
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9590 9402 4152 8092 8918 01
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J18 0360 0001 3614 7980
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PS Fort 3811. July 2015 PSN 753U•U2-U0D-9C53
items 1, 2, and 3.
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9590 9402 4152 8092 8940 24
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PS Form 381
DOmesLB Raturr Receipt
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: �//l 1 6 2wal }4& S&7 sct-&� &z4s u11 LL l
(Lot or Street #, Street or Road, City & County)
Agent's Name #: ea Mailing Address ,,J O /•Zjl
Agent's phone #: A)C 2 ,9Vt1 P
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
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastalmanagement.netlweb/cm/staff-listin_g 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.)
4-1,d— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
ture %
Zee 7// /-L
Print or Type Name
Mailing Address
1 'a /s h, 46Ly AL V6
C/itt y//'Sttattel Zi/p
Telephone--- ne_Number / Email Address
(Ptiparia Prop rty Owner Information)
Signature
Print or Type Name
1 - l
Mai ing A dress
City/State2ip / I
Telephone Number/E ail dres ��11111
RECEIVED
NOV 12
DCM WII KA1K1r--Trn.i ....

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