74660D - Stiller

❑ CAMA / WDREDGE & FILL
GENERAL PERMIT
WINew ❑Modification ❑Complete Reissue El Partial Reissue
No. 74294
A B C
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality t
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC DL 12VO
❑ Rules attached.
Applicant Name _Im o-r-- ,�h Nor Project Location: County
Address.,1908 -(.fit Yackib/",'e
City k,1 State WC ZIPWA65
Phone # ( to) _ ail
Authorized Agent & k heft
❑ Cw
❑ EW ❑ PTA als iNPTS
Affected
AEC(s):
❑ OEA
❑ HHF ❑ IH [--]USA ❑ N/A
❑ PWS:
ORW:
yes / no
PNA ®/ no
Street Address/ State Road/ Lot #(s)
SGt,^4
Subdivision
City.
ZIP
oCi
Phone # ( a) 1 oU,3 River Basin L tM�
Adj. Wtr. Body Q�WC!/ (nat IMM /unkn)
Closest Maj. Wtr. Body
f �
ME
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Agent or Applicant Printed Name J /'
Suture ** Please read compliance statement on back of permit **
1�
Application Fee(s) CReck #
Permit Officer's, PPrri�nttedd Name
Signature
�2 / s q 1!
Issu ni g aD to xpiration Date

Authorized Agent Consent Agreement
in order to obtain any
is hereby authorized to act on my behalf
(Panted N e of Agano
k permit s) required for the property listed below. The authorization is limited to tl^
specific activities described in the attached sketch.
LOCATION OF PROJECT:
PROPERTY 0WNER MAILING ADDRESS:
AUTHORIZED AGENT MAILING ADDRESS:
Signature of Property Owner:
Signature of Authorized Agent:
Date
PHONE NO. '11Q '--27 �- SJ 79
PHONE NO. 9 tb L4y 3 l c7'-4 S
4MW,4,L-1
127 Cardinal Drive Ext., Ntfkrungton, North Cm#m 28405-3845
Phone: [phone] FAX [phone] lna"et www.nowastaimanagament.net
An Eq* oppaxu* 1 At MA" ACOM EMODTer - 50% Retyped 1 i0% Pass Cmumer Paper

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATiONAVANERFORI14
Name of Individual Applying For Permit: �esf }-We L
Address of Property:
(Lot or Street 9, Stree or Road)
OAK
(City and County)
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, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
within 10 days of receipt of this notice. 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, boat house or boat lift must be
set bck a minimum distance of 15' from my area of riparian access - unless waived by me. (Y
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.
ill 0
Sign Name Date
AAXArA6
Print Name
Telephone Number with Area Code
S:\cama\shellslriparianproperty.frm
NCDE-�R
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VISION OF COASTAL MANA
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVERFORM
Name of Individual Applying For Permit: �OAIAZ�
Address of Property:
(Lot or Street #, Street or oad) .
(City and County)
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, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or can 910-395-3901
within 10 days of receipt of this notice. No response is considered the same as no objection i<
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
set bck a minimum distance of 15' from my area of riparian access - unless waived by me. (''f
you wish to waive the setback, you must initial 1 the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Sign Name
Print Name
_ 0-- gar - ge- 2
Telephone Number with Area Code
S:\cama\shells\riparianproperty.frm
Date
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RAUBWAN MARINE CONMUCTION
AP
3800 Oid Oddoe Road
Nam om*u M461
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Date Received Date Deposited Check From (Name)
Name Of Permit Holder Vendor
Check Number
Check
amount
Permit Number/Comments Recei t or Refund/Reallocated
Columnl
Column2 Column3
Column)
Column',
Columne
Column,
Column8
Column9
7/3/2019
7/3/2019 American Marine Construction/Tommy Perry
Bonner Stiller
First Citizens Bank
88684
200.00
GP #74660D
'TM rot. 8467