74812D - Marsh

CAMA / ❑ DREgGE & FILL NO. 74812 A 'B C
ENERAL PERMIT Previous permit # S
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued UD
As aut orized by the State of North Carolina, Department of Environmental Quality / �/+� `
and tFtile Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC W. 2 0�J
❑ Rules attached.
Applicant Name AQ,--5 1 Q-1k ?/.— •jc a tM Project Location: County -
Address �O _�QT� d(�G _ ^fir Street Address/ State Road/ Lot #(s)
City JJ&,A& ,-, RC L, State_ ZIP 2FC`I(La tau A k br.
Phone # ( ) E- /Mail ,� //
Authorized Agent S l_. C l ieu C , V, %1 -PH.
Affected ❑ CW OW PTA ❑ ES ❑ PTS A r -
AEC(s): ElOEA ElHHF IH El USA ❑ N/A 1
❑ PWS:
ORW: yes /�fi'�.) PNA yes
Subdivision
city ZIP Zk (O-;_
Phone # ( Io )�frOy3�( River Basin 1,bGr
Adj. Wtr. Body A I w c✓ man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printe me
Signature` Please read compliance statement on back of permit*
Applica L Fee(s) Check #
Permit Name
c_
Signature
12-5 5`2020
Issuing Date Expiration Date

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4.

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Ovir" Reques rYg Perrot:
Mailing Address:
Phone Number:
Ernah Address.
! certify that l have authorized !� s- eve S+uC + I"'
x
AgeM i Canxractor
to act on my behalf, for the purpose of applying for and obtaining all CAIVIA permits
necessary for the following proposed development: Iy\ 5t'"k l l vie-i-0
✓A V V,-P ctiv- d -P r c GI i l k', V 1 ztN tX L 1 C
at my property located at
unt
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 !ands in connection with evaluating information retated to this
permit application.
Property Owner information:
Signature
Print or T pe Name
;�'
Title
i 0' 1 ?
Date
This certificafon isvalid ffvough 1 �

U.S. Postal Service"'
1`1 RECEIPT
CERTIFIED MAIL
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DoinesticMail Only
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Certified Mall Fee ~ 0459
rn
31
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�jCeS A Fees (checkbDA add fee
❑ Retum RwelPt (hardCOPY) $ Mae 11
Return Receipt (eIGCtMNO) S Postmark
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CartMed Mall Restrt'led Delivery $ Here
❑ Adult Signature Required I
Adult Signature Restricted Delivery $
0
Postage $0. 55
M
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$ 12
I Postage and Fees 11//2019
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1214:'2019
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Tracking Number: 70181130000133585349
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GREENSBORO, NC 27455.
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November 14, 2019 at 2:52 pm
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GREENSBORO, NC 27455
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GREENSBORO, NC 27455.
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Tracking Number: 70181130000133585332
Your item was delivered to an individual at the address at 11:08 am on
CHARL©?' 'iE, NC 28207.
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November 14, 2019 at 11:08 am
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CHARLOTTE, NC 28207
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November 14, 2019, 11:08 am
Delivered, Left with Individual
CHARLOTTE, NC 28207
Your item was delivered to an individual at the address at 11:08 am on
CHARLOTTE, NC 28207.
Novayber 13, 2019, 10.33 pm
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name .of Property Owner taa rsk%,Y
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: HS Construction
Agent's phone #: [phone]
Mailing Address: 2164 Holden Beach Rd.
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
(DCM) In writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been n*V&d byOerffd MWH --
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.)
_ dL._.- l do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
11 ul r5lS Pv.A
Signqture
Cr I�LMrl , u�;�eF�IS Pori
Printbr Type Name
C D r- tAs
Mailing Address
City/State2ip
Telephone Number/Email Address
(Riga ' n rop owner Information)
Si azure
a�E xi RC-C, (IR
Print or Type Name
2
Mailin Address
I 2 te/Zip
`� � J ~�G� V ��� J / 1 �a1' �C�� il. �.�r�l^�✓C r
Telephone Number / Email Address (JV
z
Dat
Date �-
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name .of Property Owner: eta r 51n E>v nG S P�I I_�j ��,,7�, /A i- rp
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name#. H5 Construction
Agent's phone #: [phone]
Mailing Address: 2164 Holden Beach Rd.
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.
r 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 or by calling 1-888-4RCOAST.
No response is considered the some as no objection If you have been notNied 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.
4—'` 1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
ia�s �Pe,�$, !Ytu►F5 PoA
Si
.gnq1ure
0,6�g A Act,,n6w. . PAQiAe"'' . iY1tiRTS Po.A
PrinfJor Type Name
CAMs
Mailing Address
CityfStatwzip
Telephone Number / Email Address
(Riparian Property Owner Information)
Signature
C',-+r,- )nzw.
Print or Type Name
) P- F �g ate— J7 r-
Mailing Address
city/5`traterip
/y-- 7:f A-1 -,�,- 3g7r
Telephone Number / Email Address
/3/zS62 1
Dat
Date
(Revised Aug. 2014)

Daft Roe~
Dab Deposited
Check From
Name o1 PwmH NoMY
Vendor
Check Numbs/
Chaok
amount
Pe if Number1Commenft
R or RakrwLRealkxand
Cok~l
Co1mn2
Cokmn9
COMrmr
C.1-5
cok o
Column7
Coknnn5
Cokmn9
12/6/2019
12/6/2019
Eric and Viva LaChance
Mona Black Marina LLC
USAA Federal Savings Bank
1064
$ 200.00
GP #74807D
PA rct. 8522
12/6/2019
12/6/2019
Brian and Heather Mikkelson
same
First Citizens Bank
131
$ 200.00
GP /74789D
PA rct. 8514
12WO19
12/6/2019
H5 Construction LLC
Marsh Walk by The Sea POA
BBBT
2418
S 200.00
GP i74812D
BB rct. 9457
12/6/2019
12/6/2019
1 Daniel Crouch Julia Glew
Julia Crouch Christopher Duke
I State Employees Credit Union
1 10051S
200.00
IGP#74810D
IPA rct 8524