74524D - Sawyer

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DGE& FILL No. 74524 A B CO
PERMIT Previous permit #
7t4ew ' ❑Modification ❑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 15A NCAC ��� • (2-V�
n R. J..."M h.A
Applicant Name AAT TH4 \,,% S,,w JC4_
Address 2� tea %1 t w oo L't
City QCAr-1{ State VL ZIP a$46O
Project Location: County �� ti•f�C ft
Street Address/ State Road/ Lot #(s)
Phone # (-JA T_Hs 01 E-Mail rflSrw�}ar• (7�lct �. Subdivision
Authorized Agent City ^—r ; GA0
ZIP 2.Syy3
Affected ❑ CW MW f(PTA ❑ ES ❑ PTS Phone # ( ) River Basin `hJM 1 T E OAK.
AEC(s): ❑ oEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body —TJ Py� S 0.I N D a an /unkn)
❑ PWS:
��-� (1--t M'i Wtr Rnfiv A I W `+�
Agytor plican anted NamSi Please read compliance statement on back of permit
Application f ee(s) heck #
Permit0 icer' inted Name
Signature
7 -22-P -
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
Matthew Sawyer
127 Driftwood Ct
Wrightsville Beach, NC 28480
704-576-0428
[e-mail]
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Dock / pier with a gazebo
Boat lift and a floater
at my property located at
in Pender
County.
1475 Kings Landing, Hampstead, NC 28443
1 furthermore certify that 1 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
Matthew Sawyer
Print or Type Name
Title
7 l� lIq
Date
This certification is valid through / /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Matthew Sawyer s
(Name of Property Owner)
property located at 1475 Kings Landing Dr, Hampstead, NC 28443
(Address, Lot, Block, Road, etc.)
on Atlantic Intracoastal Water Way in Pender N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locon/.
✓atiI 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)
Installing a dock/pier with and observatory area along
with a boat lift and a floating dock.
Site drawings are attached
WAIVER SECTION
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Print or Type Name
1475 Kings Landing
Mailing Address
Hampstead, NC 28443
City/State/Zip
704-576-0428 [e-mail]
Telepl),One Number / email address
Date
A
Telephone um er email address
Date
(Revised Aug. 2014)
`Valid for one calendar year after signature*

DocuSign Envelope ID: B231A206-6048-403B-8849-94F55DA15A75
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
Matthew Sawyer I
(Name of Property Owner)
1475 Kings Landing Dr, Hampstead, NC 28443
(Address, Lot, Block, Road, etc.)
on Atlantic Intracoastal Water Way in Pender N.C_
(Waterbody) (City/Town and/or County)
T,heiapplicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
Installing a dock/pier with and observatory area along
with a boat lift and a floating dock.
Site drawings are attached
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.)
DS
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement
(Property Owner Info ation)
i rnalzire
12 c(/t'Acty Saej
Print or Type Name
1475 Kings Land ng
Mailing Address
Hampstead, NC 28443
066state/Cip
704-576-0428 msawyerseatestatefgmaitcom
Telepfpne,Number/ email address
06f/1l// e?
Date
'Valid for one calendar year after signature'
(Adjace t ,O. wner Information)
C ,1nc,.a St�2QQti
Signature *
Charles stellar
Pnnt or TyegBamemarl a street NW
Marling 44*%ton
C"Y/Sta�aington DC 20008
Telephone Number/email address
6/17/2019
Dale
(Revised Aug 2014)

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Date Received
Dafe Deposited
Check From (Name)
Name orPermft Holder
Vendor
Check Number
Check
unt
Permif Numbe lComments
Receipt or Refund/Reallocated
Column!
Co_lumn2
Column3
Column)
Cofumn5
Cof mnO
Column7
Co1u_m_n8
Co1umn9
7/23/2019
7/23/2019
_
Alan Dale Clemmons _ _ _
Sawyer Properties LLC
Dale Clemmons
BUT
5860
$ 200.00
GP #74525D
GP #74524D
JD ML 9157
BB rct. 1544
Matt Sawyer
_ _
Wells Faroo Bank
1027
$ 200.00