73515D - Newton

4CAMA / DREDGE & FILL
GENERAL PERMIT
mew ❑Modification ❑Complete Reissue ❑Partial Reissue
No. 73515
Previous permit #
A B C
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 Wo
❑ Rules attached.
Applicant Name VIP.( %)J%A NeWToA
Address_ r� 10 fjOS
City SHALLOTTE State NC ZIP_ Lf 59
Project Location: County ?)2u j&wicK
Street Address/ State Road/ Lot #(s) ISIS FM S14 AWk L1J
Phone # (3&) -K4 3sl $ E-Mail /A Subdivision
Authorized Agent +HS Cowravc1fop1 U-C A-T-1 City SHALLoTTE ZIPA84,70
Affected El CW X Ew Kp rA ❑ ES ❑ PTS \.� Phone # (W) WO 4381 River Basin L,V r U,ram
AEC(s): C' OEA HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body SHALL OTT C RtyM Oman /unkn)
ElPWS:
ORW: yes / (10 PNA yes / 10 Closest Maj. Wtr. Body N�Ww --
.,.
length
number
khead/Riprap length
avg distance offshore
max distance offshore
in, channel
cubic yards
ramp
house/ Boatlift
h Bulldozing
her awl A2
reline Length
tos: yes
iver Attache t�
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Agent o, ^
r Applicant Printed Name
V
Signature ** Please read compliance statement on back of permit
$tot) -4:2310
ppli A-�Fee(s) Check #
I YLE(Z A c C t1l>t-r—
Permit Officer's/Print Name
Signature
(o1G�2o{9 io (c Zo{1
Issuing ate Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Virginia Newton
Mailing Address:
Phone Number:
Email Address:
3518 Marsh Hawk Ln.
Shallotte, NC 28470
910-754-3518
I certify that I have'authorized H5 Construction LLC
,gent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMPS permits
necessary for the following proposed development:
remove and replace 12'x16' floating dock in existing footprint
at my property located at 3518 Marsh Hawk Ln. ,
in Brunsw#ck 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:
Signature
Virginia Newton
Print or Type Name
Title
j/a- ";� /fib/
Date
This certification is valid through 1 !

l hereby certify that I own property adjaoerd to Virginia Newton 's
(Name of Property Owner)
petty located at 3518 Marsh Hawk l.n., SW
(Address, Lod, Block, Road, etc.)
on Shallotte River in Shallotte N.C.
(Waterbody) (CityfTown andfor County)
The appfic ani has described to me, as shown below, the development proposed at the above
is
I have no objection to -this proposal.
I have objections to this proposal.
DESCRiP "ON A%DPOR DRAVA%G OF PROPOSED DEVELOPMENT
(Individual proposing dilw elopment must fill In de don below or attach a site drawing)
Demo and replace 12' x 16' floating dock in existing footprint
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
5f� 1 do wish to waive the 16' setback requirement_
i do not wish to waive the 15' setback requirement.
(Property Owner Information)
J
Sfgnar
---- V I RGIArI.4 ter . Af E/) MV
Print or 7ypA Name
o ffLTX_„
Mafll�sr Acktress
C4ty!W&1q2a
N l o)
Tate "A Number/emall address
Dat8p
(A rft P Owner Information)
Signature'`
r �
Print or Type Name
1131Ir-ra�elrj C
Mailiingn�ddress
LDS I N ZS i
('i��� I
'Telephone Number/email address
Date
(Revised Aug. 2014)
"Valid for one calendar year after signature*

---N
• Complete ftSMS 1, 2, arlU
• Print your name and addrg�,O;,tih-e reverse
x
so that we can return the card to YOU.
• Attach this card to the back of the mallplece,
or on the front If space MmIts.
D. Is
1. Articia Addressed to:
If,
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3 Ser
� Aduft
9590 9402 4454 8248 7531 94
0 AcUt
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3517 MARSH HAWK LN
KNIGHT
MARSH HAWK LANE
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1214 RIVERVIEW
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7

Date Received
Da re DepositedCheck From Name
Name o/Permit Holder_
Vendor
Check Number
Check
amount
Permlr Numb—Commems
R—i r or Refund/Reallocated
Columnt
Column2 Column3
Column[
Columns
ColumM
Colum,
Column9
Column9
/1 312019 H5C V inia Nevon BUT
50 TM r 9