74243D - Sellers

XCAMA / DREDGE & FILL
GENERAL PERMIT
XNew JModification ❑Complete Reissue ❑Partial Reissue
A B C `t
Previous permit #
Date previous permit issued
No. 74243
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 0 7 A. 12.0a
❑ Rules attached.
Applicant Name N Project Location: County njP%AAIJ W 1 c.IL
Address 13 �t._EA.SAn/T (�R Street ddress/ Sltate Road/ Lot #(s) 1 ( 5
City esµASVIt.�r� State JC ZIPV7 6v 4 C7N ow-r 5
Phone # 0-3AP) 241- 4'1 IM E-Mail /CIA Subdivision
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Authorized Agent AMDA Cialcr- City AILVr w/ $f^cal ZIP 2s444—
Affected ❑ CW EW I PTA El ElPTS �� An Phone # ( I o) 51 y- 9� 9 5 River Basin L r� p
❑ OEA ❑ HHF ElIH ElUBA ❑ N/A /+
AEC(s): Adj. Wtr. Body (�-A.✓AL (nat man /unkn)
❑ PWS:
ORW: yes / no PNA yes / ©o Closest Maj. Wtr. Body �% w
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Agent or Applicant Printed Na
Signature ** Please read compliance statement on back of permit
$ '-2� _ zli� 13002-
Application Fee(s) Check #
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Permit Officer's Printed Name
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Signature
51312a 19 /712y 19
Issuing Date Expiration Date

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NCDRA
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuKM
Date-
Name of Property Owner Applying for Permit:
moo" U
Owner's Mailing Address:
Phone Number A^) 0241-gitilyi-
Name of Authorized Agent for this project:
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Agent's pMailing Address:
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Phone Number AL1icfy 9 Gq
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at
This certification is valid thru (date)
Prope Owner Signature Date
127 Cardinal Drive Ext., Wilmington, NC 28405
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opporturky 1 Affirmative Action Employer

U.S.
Postal
Service'"
CERTIFIED
MAIL°
RECEIPT
Domestic
iNail
Only
For delivery
information,
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website at www.usps.com
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■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we cd6 rgturn the card to you.
■ Attach this card, .the back of the mailpiece,
or on the front ifpce permits.
1., Article Addressed to:
A. Signature 1
x�/ ti�� ❑ Agent
❑ Addressee
B. Received by (Printed Name) Ci Dtt of Delivery
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D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
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3. Service Type
❑ Adult Signature
❑ priority Mail Express(D
9590 9402 2219 6193 1046 84
❑ Adult Signature Restricted Delivery
=ertified Mail®
❑ Registered MailTM
❑ Registered Mail Restricted
❑ Certified Mail Restricted Delivery
Delivery
-return Receipt for
Q, Articla Ni imhor ITrancfar irnm caniira laholl
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
Merchandise
El Signature ConfirmationTm
7 017 0660 0000 7487
0 2 7 6
ElSignature Confir lion
stricted Delivery
RestrictedDelivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

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CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. A'�)n
Address of Property:
P& --� �5
(LWor Street #, Street or Poad, City & County) —
Agents Name #: - C kt (k n"4 XJ'W�) Mailing Address:U M 3QQCh
Agent's phone #: y 5-1,"qm,5 — -t ( 2`6%q
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.
have no objections to this proposal I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal
Cr C Management (DCM) in writing within 10 days of receipt of this notice. Corres a should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represendiftse can also be
C contacted at [phone]. No response is considered the same as no objection IdYW 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 distanc of 15' from my area of riparian access unless waived by me. (If you wish to waive the
set ck, you st 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)
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Print or Type Name
113 PI � D;-
Mailing Address
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City/StatelZip —7
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Telephone Number
Z-ICI
Date
perty Owner Information)
Print or Type Name
M ding dress
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City/State/Zip
c�( �-776 7
Telep one A
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Date
Revised 611812012

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■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
A. Signature
B. Received (Printed,
Agent
❑ Addressee
C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
I IIIIIII IIII III I II II I II I I III II i I it III illl I I3. Service t iA nRegistered
egiedts IITM
❑ uISgntue Restricted Delivery ❑ es�Mail Restr cted9590 9402 2219 6193 1046 77 ertifed Mail® Delivery
Q Certified Mail Restricted Delivery turn Receipt for
❑ Collect on Delivery Me u.'I dise
2 "' ''' "' ^- ? ^+ . f nm caniicq lahall ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmationw
7017 0660 0000 7487 0269
I I Signature Confirmation
Restricted Delivery Restricted Delivery
5 t-orm JbI 1, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: A�,-)
Address of Property:
Pa,-,�� 5
(I-Wor Street #, Street orRoad, City & County)
Agent's Name #: U r tct �5�� �1(,�Iy�1 Mailing Address:CUtU I fJ 3QC\) ►>—
Agent's phone #:%u-rJ�(+quqrj &�-n N( 2,S%q
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 Orawin the development they are proposing.
C" A desorlotion or drawing, with dimensi
6
i have no objections to this proposal. _ I have objections to this proposal.
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. Correse should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represe can also be
C contacted at [phone]. No response is considered the same as no objection 0pOWaeen
notified by Certified Mail.
Gy WAIVER SECTION
V 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)
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Print or Type Name
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Mailing Address
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City/State/Zip
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Telephone Number
Z-�CI
Date
(Adjacent Property Ow er Information)
ignal ure
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Print or Type Name
Mailing Address
City/StatvZip
Telephone Number
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Date
Revised 6/18,,2012

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Date Rived
Date De sited Check From Name Name of Permit Holder
Vendor
Check Number
Check
mount
Permit NumbenComments
Receipt or Rclund/Reallocated
Columnt
Col-2
Co1umn3 ColuMME
Columns
Column6
Column7
Column6
Column9
Oon of Brunswick Co - Inc ah n Sell rs
BUT
1300
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GP#74243D
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