74761D - Lopez

❑CAMA / -. DREDGE & FILL NO. 74761 A B C
GENERAL PERMIT Previous permit #
41ew Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality n
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC CJ
�� I O / / l /�7 Rules a ched.
Applicant Name �/ �/�o�l Project Location: County ems( t
Address H rr U Street Address/ State Road/ Lot #(s) Oe
City Ud State PC ZIP 7g-tlS ' �� �< i / SUN C
Phone #7. Z�E-Mail Subdivision
Authorized Agent NIA— City 5 ✓ ZIP "�/ y S5
Affected ❑ CW )67E �J PTA ❑ ES ❑ PTS Phone # ( `-j— Riv r Bassj.n {/v d
AEC(s): ❑ oEA / ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body �qL
C PWS. na man unkn
ORW: yes / no-) PNA yes (ono
Closest Maj. Wtr. Body
Type of Projec Activity
WA
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Ag or Applicant Printed N
Signature ** Please read compliance statement on back o PT
Application Fee(s) Check #
Issuing Date
Printed Name
3• /-2.)
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C S-CSPeZ
Mailing Address:
c;
Phone Number:
Email Address:
LA
I certify that I have authorized [a ,
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
in JLCC (- County.
l 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:
(Dv,h.Qc
Title
C& CA
Date
This certification is valid through
RECEIVED
OCT 2 S 2019
DCM WILMINGTON, NC

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A ck 56A s
(Nanto of Propefty Owner)
property located at
n� ZC. W (Address, Lot, Block, Road, etc.)
on
in � 4m , N.C.
(Waterbody) (CltyfTow nd/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
✓ I have no objection to this proposal
I have objections to this proposal MUNI
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT 1 .1
(individual proposing development must till in description below or attach a site drawing)
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T
j. - 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.)
do wish to waive the 15' setback requirement- ".
I do not wish to waive the 15' setback requirement- ,
7rMpt7rrr Information) (Adjacent Prope ner Information)
i
Signatur Si nature f
Print or Type Name+ Print or Type Name )
Mailing ddr ss Marling Address
Su�t~k 9-y ,WS 'SL.'r-C t''14( ,rJc.
City/State2ip S yp� City/Stale2ip
Chi a ( .earn
Tele 0'11 Y Telephone Nurnber
a!¢ Ua1 r
OCT 2 4 2019
(Revised 611812012)
DCM WILMINGTON, NC

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24 2019,
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RECEIVED
OFT 2 4 2019
DCM WILMINGTON, NC

10/1'7/201a 12.8 ft. x 11.2 11.-56 Block PWC t.ift.2jp9.jp9
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NO
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Date Received
Date De sited
Cheek Fom
Name of Pennlf Holder
Vendor
Check Number
Check
amount
Pennlf NumbenCommenfs
Receipt or RefundlRealk cated
Cdumnf
Column3
Cokmn3
Co1umn4
Col~5
Columns
Cok-7
Column3
Column9
11/1/2019
Carolina Craftsman. Inc.
Leland Helms
BB&T
3816
$ 200.00
GP 074544D
Tmc rct 8292
11/1/2019
Richard and Susan Hutaff 1 of 2
some
First Citizens Bank
6123
$ 100.00
GP €74731 D
PA rcL 8507
11/1/2019
Richard and Susan Hutafi 2 of 2
same
First Citizens Bank
6054
$ 5W.00
GP 974731D
PA rct. 8507
11/12019
Willie Clarence Richardson/Richardson Co
Stephen & Paula Webb
BB&T
7562
S 200.00
GP #74547D
TMc rcL 8294
11/12019
Gaston F and Janell LopezGaston
LopezNly
Bank
1198
S 200.00
GP 974761 D
JD rcL 9066
11/12019
Clements Marine Construction
Tracy Shakespeare
First Citizens Bank
5278
$ 200.00
GP #74599D
JD rct. 9065
11/12019
F and S Marine Contractors Inc
Dennis Moeller
PNC Bank
8171
$ 200.00
GP #74762D
JD rct. 9064
11H2O119
Thomas G Day III
Thomas Day & Madeleine Vanston
Wells Fargo
103
$ 200.00
GP 974730D
PA rct. 8508
11/12019
JW & MT Dowless
John Dowless
BB&T
8341
$ 200.00
GP 074774D
BB rct. 7937
11/12019
Carolina Creations Landscapes, Inc.
Jacob Betts
First Bank
10382
200.00
GP 974775D
BB rcL 7938