71744D - Mann

XCAMA / '� DREDGE & FILL C�� No 71744
GENERAL PERMITC� e, -4,70t q .Tyf A
Previous permit #
New - Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �y
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / F ( z O O
I-1 Rules attached.
Applicant Name M ICI-1A><L.. M AIVN
Address 17_3 Tc, I "JT Y�I I owA, i L s jn/
Project Location: County
f, C to n/ .S w I C I<
Street Address/ State Road/ Lot #(s)
City _5'NAu oT-rr_ State NC ZIP Z W(D
Phone # (1?03) 391- 9 Z.(i6 E-Mail M d r"Art V1 C hc+r,,a;l . Cot-, Subdivision
Authorized Agent A/0Al E City ZIP
B C O
Affected ElCW
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Phone # ( �)
River Basin L LA m tm iz
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PNA yes /
Closest Maj. Wtr. Body
Type of Project/ Activity =Al f-f ALL— _PR %Vr- - Gn1 FLOAT Do c K u
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A building permit maybe required by: FRIA/)SH11 C K COLA/VTy ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions 7 12 0 O A j> A LA- O T NE R LO CA L 8 ..STA-rC ND
tV) I i
Fr_-oEszAt- 12EC1CALATIONS APPLY.
NA Om �\
Signature ** Please read i ompliance statement on back of permit *'*
It ,700 ZI 94
Application Fee(s) Check #
j LC (Z M C 6 LA I2r—
Permit Officer's Printed Name
Signature 14,
r, 23 2019 S 23 zol9
Issuing Date Expiration Date

■ Complete items 1, 2, and 3.
■ 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
�3 �j
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A
%Tj
0 Agent
Received by (Printed N.Ine) C. e o
n 0 Sin J)w ) ► i
D. is delivery address dlUerard from item 1? ❑Yes
it YES, enter delivery address below: No
3. Service Type ❑ Priority Mai Express®
IIIIIIIIIIIIIIIIIIIIIlIIIIIIIIIIIIIIillillllll ° °
o Restricted red Mail Restricted
❑ Certified Mail® 0 MerchandiseerY for
9590 9402 4454 8248 7421 29 o ce� Mail c DRed try
2. Article Ntxnber (rs service fahe►)
❑ Cofiect on Delivery Robin ted Delivery ❑O Signature
�Tm
from Restricted Delivery
7018 0680 DDDD 7024 6948 aP"triawd'
pgpestic Return Receipt
PS Form 3811, July 2015 PSN 7530-02-000-9053
■ Complete items 1, 2, and 3.
■ 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 mailpiece,
or on the front K space permits.
1. Article Addressed to:
Iliiilllilllllllllllilllllllllllllllllilllllll
9590 9402 3923 8060 3020 04
2. Article Number Crraacfar^
18 0680 DODD 7024 1394
PS Form 3811, July 2015 PSN 7530-02-000-9053
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db-
A. Signature
�,/ 0 Agent
X kY/l. ' ,,, i .0 D- j 0 Addre
B. Received by
C. Data of Delivery
D. Is delivery address awj �Om item 1? ❑ Yes
if YES, enter delivery address below: ❑ No
3. Service TYPO
❑ Adult Signature
❑ Adult Signature Restricted D*-V
0 Certified Mail®
❑ Certified Marl Restricted Dd—y
IJ Collect on Delivery
❑ Collect on Delivery PAWldled DOW"
❑ Inswed Mail
❑ insured Mail Rued t70rrvety
of
13 t?istered Mail Restricted
rvery
❑ for
MerchBrKNSO
0 Signature Confirmat '
0 Signature confirmation
Restricted Dehv"—
Receipt
q,�cev� oz�uzyZSC�'�,'
� (J44,;RECEIVED
2019
DCM WILMINGTON, NC

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Michael D. and Barbara R. Mann
Name of Property Owner: _ 1739 PT Windward PL SW
Address of Property: Shallotte, NC28470-5560
Agent's Name #: Mailing Address: _
Agent's phone #:
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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. 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, brea , oathouse, lift, or groin must be set
back a minimum distance of 15' from y area arian access unless waived by me. (If you
wish to waive the setback, you us i ' the appropriate blank below.)
I do wis walMthe 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro e O r Information)
90wa-VI.
Signature
mtC-ff"z- I). MI J
Print or Type Name
Michael D. and Barbara R. Mann
1739 PT Windward PL SW
Shallotte, NC28470-5560
3 847 - 9c;2 6-s-
Telephone Number
1 f�
Date
(Adjacent Property Owner Information)
X
Signature
imo�JR Ffiy6- bI-A � s
Print or Type Name
6 / etas D2 i ve
Mailing ddress
W I I //M /J
City/State/Zip
Telephone Number
x
Date
Revised 611812012

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D,ft
Deft RacNwd
Check From Name
Name o1 P—,W NWder
Vendor
Check Number
Check —t
Permit Number/Commenft
Receipt or Rerund/ReaBouted
CWumn1
CWUM2 Column)
CWumn1
Columns
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Col-8
Col"nB _
1/27/2019
!Michael or Barbara Mann
same CresCom Bank
2194 $200,00 GP # 71744D
TMc rct. 7302D