74767D - Qubain

�r _ CAMA / DREDGE & FILL NO. 74767 A B C `+
GENERAL PERMIT Previous permit #
)(New JModification ❑Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r7
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC d / j-{ •
❑ Rules attached.
Applicant Name VA vt. xT HrR to s A l t/ Project Location: County Ar F_ t J 0 A/JOy t-TZ
Address !740 5 4 LAGS WAY
City " f cIGId State ZIP 2.76IS
Phone # (49)'?15- 31:31 E-Mail tj
Authorized Agent 'V— p TIr4Ni1
Street Address/ State Road/ Lot #(s)
19 plPf-f.s /rEvc
Subdivision rtowkRlt� EwH"r
City 0 K W,,J GvrOrJ ZIP Z $4 1
Affected El El
XEW %PTA El ES ElPTS A c-rrfiT Phone # (4m ) Z,S(.- �oG2 River Basin W VA V R K
ElOEA ❑ HHF ElIH El USA ❑ N/A /� ./
AEC(s): Adj. Wtr. Body CAJ✓A4— at man /unkn)
Ager nt inted Name
Signature* Ple a read compliance statement on back of permit
!$/,Do _# 8306,
Application Fee(s) Check #
Kc-
Permit Officer's Printed e
Signature U V
I Z k3 I /I `1 SA 202-0
Issuing Date Expiration ate

Pat McCrory
Governor
LTXWJ
NCDENR
North Carolina Department of Environment and Natural Resources
N.C. Division of Coastal Management
John E. Skvarla. III
Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Nam f /6SO
Authorized Agent for this project:
Owner's Mailing Address:
,6 6
Email: !.>!►i1 c (&1-U,► 4
Phone '
Agent's Mailing Address:
fwfarmw
PC).. Box 868
Wrightgvii1e Seaoh, NC 28484
Email:,`JL°►�if/ Al. ;:, 2a5-8062
Phone i )
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and obtainin all CA► Permits necessary to install or construct the following (activity,
For my property located at
This certification is valid 1 year from (date,
11/12/19
Property Owner Signature
Date
127 Cardinal Drive Ext., Wilmington, NC 28405
Phone: [phone]', FAX: [phone] Internet: wvay.rccoastalmanagernent.net
An Equal Oppnrtunit.- Affirmative Adoon Employer

Ite
NCCR RD/'/
PATNCKC, BNSTOW BOAT BA51N ,' i II LOCATION MAP
N.C. PLS No. L-4148 NOT TO SCALE
5URVEY REFERENCE_
````��t��
CA'''' MAP BOOK 14 PAGE 3
.`N RO � / / J II DEED BOOK 4485 PAGE 77G
SEAL
_ / I NOTE: THI5 LOT 15 LOCAf I'D
-p : I �yy b [� J- I IN ZONE A5 PER
-9�. L-4148 O ` / _ ' MAP # 37203 17800 K
.... ''�Gj;�� COMMUNITY ID # 3701 G5
nick C. 8 ���� FLOATING J N DATED: AUGU5T 2.5, 2018
DOCK / tii1 (0 J II
BL FLOATING
BL DOCK
PIER //dlsFb 6L JFLOATING II /
5URVtYED LOT 15 5UBJECT TO ALL DOCK
/ I
EASEMENTS, RESTRICTION5 OR PIER
COVENANTS OF RECORD. !/ /27 J I
/ PIER J I
LINE A5 PER J
BULKHEAD �`,� RECORD PLAT J
//HWL+ �lA►� o
P \ HWL AT FACE
/ `.4 /, J U'VLL-pTiju OF BULKHEAD
/
�
C)� ,
N/F FIGURF 9 PARTNFR5, I C /Vl uw 14mV \
DB 5815 PG 28G9 %hor1 Q
/ n ` N/F HILDA CAMERON \
DB 1 157 PG 332
LOCATION OF ALL SHOWN r — GD PIP
Ou &lk, G
IMPROVEMENT5 15 RELATIVE TO !" TH15 MAP AND FIELD 5URVEY WERE: MADE
CONTROL MONUMENTS SHOWN ti

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: y w IHU�'"
Address of Property: / M, 4
Agent's Name #.
Anent's phone #:
Mn
w1)A)41,7yV1 V6.
(Lot or Street #, titre
qJ0
or Road, City & County) j
Mailing Address:11
GIri+6lfi3WN �=41 Y,z
:ertify that I own property adjacent to the above referenced property. The individual
x this permit has described to me as shown on the attached drawing_the development
roposing. A description or drawing with dimensions must be provided with this letter.
I have no objections tq this roposal. I have objectio s to this proposal.
o
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, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
/kfic,A,� Q
Signature
k�
Print or Type N me
� yK 5 flit 0o w,m
Mailing AhdJais 1 r I
t
I'�yrl I?1A
Citrate ip
Te/anhone Number
Dare
bath
Print or Type Name
fib& `d V84
Mailing Address
P,44W6111 )V'Y i
City/State ip
Teleph ne Number
aa/ 4/1 A q
Date
Information)
n
Revised 611812012

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RiPARIA�Nf PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: _ % K W V,�)1-'-n A t
t? �1/Lw yJ w � c Vila
Address of Property: 11 )►1l ,
iLot or Street #, 61reet or Road, City & County)
' ✓t /
Agent's Name m: �"f 1 ` �� Mailing Address: ����' �v
Agent's phone'"': J1 0' ��" 1.f 61�3u'� �=4, l ,z 2,9 V0
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
thjey are proposing. A description or drawine with dimensions. must be orovided with this letter.
( X�- — i have no objections to this proposal. I have objections to this proposal.
1f 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.
r 4e-
WAIVER sECTtoty
�yyw 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
,,,sh to wai a the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
$i�rrulrtr�c�
Tn. �k�Jl�l.fl
Print or Type N me
�K► 5cle"
Availing A46djads
96 L. a761 S
Cilyl,late ip
Telephone Number
( djacent Property awU
r Iformation)
U�-
Si2liatlwe
A Uh A 1 �2)
t or ype Name
�� Ll 3��9
P '
Mailing Address
m,1, o2A,,, N,6, 2M
Citylstatelzip
Tb0v1 DK
Telephone Number
-
P,evised 611 PI2012
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