74360D - Mauldwin

"C
FE
/ ❑DREDGE &FILL No. 74360
GPERMIT Previous permit# A B C
O
NModification ❑Complete Reissue ❑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 I SA NCAC 0 7 14 12 0
❑ Rules attached.
Applicant Name yAAR L-E S M A L&s<-p W N
Address 2 2 O 1 Stl E,A C IL
City DAVIUSoN State 4C ZIP Z903c,
Phone # (704)241 - 830 $ E-Mail Al1A
Authorized Agent CAA9.L5 N 1Z
Affected ❑ CW )<EW j(PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Project Location: County &N,,JS w 1 c K
Street Address/ State Road/ Lot #(s)
-�AR1C_ S'Tfz:E.11�-r
Subdivision
City OCEA4 9FAc-H ZIP �28. 69
Phone # (33l,) G 39 - q 7 9 8 River Basin Lu m or m
Adj. Wtr. Body_ CANAL. (nat m_ 0 /unkn)
Closest Maj. Wtr. Body A I W W
Type of Project/ Activity g1=p,' AcE �)(151 1IVG L)J`5cV_' iAJ4r� TAC11_I-ry
(Scale:1" = Zp ' )
Pier (dock) length
Fixed Platform(s)
,Froating Platform
anger pier s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
{ 1(,'
Boathouse/ Boatlift
Beach Bulldozing
Other O (nl = 1.2 0' -f4 Z
C
Shoreline Length J O
SAV: not sure yes no
Moratorium: ( yes no
Photos: yes no
Waiver Attached: yes 0
A building permit may be required by: OCEAA/ ISLE- BFAc►1 ❑ See note on back regarding River Basin r}l
( Note Local Planning jurisdiction) i�- ' /f r ` G yi
Notes/ Special Conditions O'7 H . 1,2oo ge AILL 07-F1Ei2- 1-0CAL , ST r &
FF_Vr-RAL. REGtwt_ATioNs APPLY,
0
Agent or Applicant Printed Name 1
Signature ** Please read compliance statement on back of permit **
$200 1(13
Application Fee(s) Check #
-iv ErZ_ N( C_G(A.IfZ-f--
Permit Officer's Printed e
Signature
5117;2011 9 /17�2oJ9
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 6wales m,
Mailing Address: C9 DO / StVEAh'14--l'?
DR v�'1�56rV NC
Phone Number:
Email Address: n
I certify that I have authorized�/��es
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 4,Ll1.Eo lz l� _
A U
at my property located at co 74
--
in 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:
Signature
Print or Type Name
Title
�
Date
This certification is valid through _ 7 1 6 l-/

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 1 /n 9ALLUUtti,'s
(Name of Property Owner)
property located at L'% s ��
(Lot, Block, Road, etc.)
on , in_�� _, N.C.
(Waterbody)
(Town and/or County)
Applicant's phone #: 7d'/`o�`f/"X�d4Mailing Address: °� "� X'o
424t/,r en/ /U` I M x
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
— I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPWN`I`i
(To be filled in by individual proposing development)
(Information for Property Owner Applying
2 for Permit)
'J'0-©d s� k1
Mailing Address
(Riparian Property Owner Information) ..<-
0 �1Z� ds5ian /1) - /j
City/State/Lip
Telephone Number
41
Signature
Print or Type Name
%0 `I - SOS— 610
Telephone Number
X� 0 / -/
Signature Date Date
1611!�//l

NAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 6. ZAo m mwkgd,� s
(Name of Property Owner)
property located at —J,2Ga4,4 7 5-1
(Lot, Block, Road, etc.)
on , in _ ay�"� , N.C.
(Waterbody)
('Town and/or County)
Applicant's phone Mailing Address: ar7Q/t.►e.t '!
0�v%flsun 28o3Cf 7
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I5') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
V I do not wish to waive
I do wish to waive that setback requirement.
-------- ---- ------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
7 (Information for Property Owner Applying
for Permit)
_ UC9
/ /�
/f ACC
Mailing Address
City/State/Zip
2 0 V - //- CS '.- 'ate
Tellephone//Number
NOL6,j
1lil�lcL�C�u? Lyc
4t_
(Riparian Property Owner Information)
( Signature
Print or Type Name
o �14-2,-z/-5z.
Telephone Number
Signature Date Date
clV11

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Check
I
Date Received
Date De sifed
Check From Name
Name of Permit Holder
Vendor
Check Number
amount
Permit Numb—W.
Race! t or Retund/Reallocated
Column!
Column2
Column3
Column4
Columns
Column8
Column7
Column8
Column9
512112019
Ma Ann M rk Mauldvnn
Chanel Mauldvn
I TMc rd 8481