74760D - Riley

CAMA / DREDGE & FILL No. 74760 A B C
CiEN ERAL PERMIT Previous permit #
New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality J oo 'F ��DO
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC t t
GA(LY SA7tiPt.� PAN 760 �'U �ORu1e�g ched.
Applicant NameIf
] Project Location: County r V� F-
Address 35� 35q- WOOO LnJ '
City 7,"-P State II ZIP
Phone # t 0 } 4'� ` '�5' d } E-Mail
Authorized Agent N / Pr
Affected ❑ CW [)5fW �OPTA 2QES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
ORW: es no PNA yes 40
Street Address/ State Road/ Lot #(s)
'�S Ill � I Ste- 'DCC"Wooc) l�N
Subdivision
City �t-i w eIZIP Zx443
Phone # ( River Basin \/V 0
Adj. Wtr. Body '4- Itt- SO v nat man unkn
Closest Maj. Wtr. Body 7fi5rS,AIL 56C)ATO
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Name
/ SignaZre ** Please read compliance statement on back of permit
Ap icatio ee(s) Che���#
Pe it icer's Printed Name
S' n ure
Issuing Date Expiration Date

• AGENT AUTHORIZATION FOR CAMMA PERMIT APPLICATION
Name of Property Owner Applying for Permit:2
Mailing address:
Phone Number: C3!
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at 3� il-lr4 2 rj e-
ink _ County.
This certification is valid through
Date
(Property Owpd-r,information)
ure
Print or Type Name
04) rdeP-
Title
ate
910-A44S-.S (
Phone Number
�f a# Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to e�L Y-✓l
property located at
on A- in
(Waterbody)
(City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distanc my area of riparian access unless waived by me. (If you wish to waive
the setback, yo must initia appropriate blank below.)
1, I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to �R' �' S ^ 12, .�1�� _ s
zz Jpafne of Pro Owner
property located at J 5 DG' G�,IJo - �—�2_ c ��
( ddress, Lot, Block, Road, et .)
on �_ Gc �. , in , N.C.
(Waterbody) (City/Town and/or County)
The applican has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distanc my area of riparian access unless waived by me. (if you wish to waive
the setback, yo ust initia appropriate blank below.)
4LI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Property Owner Information)
signa tleeJ
R `]
Print or Type Name
3S -7 D o 4
MailinV jAddress J^� �' U
S , AA - �-�l 1
City/State/Zip
t, E I l
Telephone Nurnbe ' +
Date
(Revised 611812012)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Q C� I J 0 ^ uA, C-.,l
Address of Property: �5 o� wo11S C-e-'-
(Lot or Street #, Street or Road, City & County) -T
Agent's Name #:
Agent's phone #:
Mailing Address:
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.
J p p
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 a setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property 96n r Information)
Signature U
Print or T ame
:5,sE�aA L4xle
Mailing Address
City/State/Zip
Telephone Number
w 1*2n?
Date
(Adjacent Property Owner Information)
Signatu • _
Print or Type Name
Mailing Address
2,F'Y y.�
City/State/Zip
0.) (-/� -7
Telephone Number
/C> /2-Y / 5
Date
Revised 611812012

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
J
Name of Property Owner: U -A IC.Yn S
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
v s e#A, hr
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.
ct1.o I have no objections to this proposal, I have objections to this proposal.
J P p J p P
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 Lou have been notified by Certifited 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.
Signature
I do not wish to waive the 15' setback requirement.
er Infor ion) (Adjae,6flt Prgorjy Owner Information)
2:)
Print or Tye Name
�s� ) U-)
Maili g Address
(f 43
City/State/Zip
9Id/0g3 "51�
Telephone Number
) o I ? -� f Eb 'I
Print or Typel**e "(
Mailing Address
Z/� 1e Me -z�qi�
City/Stat Zip
'1� -
Telephone Number
e/"),y�9
Date 1 Date
Revised 611812012

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #,
Agent's Name #:
Agent's phone #:
or Road, City & County)
Mailing Address:
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 / I have no objections to this proposal. I have objections to this proposal.
p P J P P
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 wai the setback, you must initial the appropriate blank below.)
r 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property,01'Qeration)
Signature U v
Print or Type lUme
SCSI cdQo L
Mailing Address
944a
City/State/Zip
�l In
Telephone Number
tol z��
Date
(Adjac Prope O ner Information)
O
(71
Signature
l
Print or Type Namey
Mailing Address
CifylStatelZip
IALI
Telephone Number g
lU
Date
Revised 611812012

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Check From Name
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit NumberlComments
Receipt or RetundlReallocated
Column)
Co/umnl
ColumnS
Columns
Column?
Column8
Column8
F and S Marine Contractors Inc. 1 of Julie Smith
F and S Marine Contractors Inc. 2 of I Julie Smith
Jonathan and Olivia Riley IGarySample&Jon Riley
Soundtronics Inc. Gary Sample & Jon Rile
PNC Bank
8177
8162
$ 200.00
$ 400.00
_
GP #74772D PA Mt. 8509
GP #74772D PA rct. 8509
GP #74760D JD rct. 9067
GP #74760D JD rct. 9067
PNC Bank
BB&T
BB&T
3243
$ 200.00
1 60161
$ 400.00