74244D - Sparks

CAMA / DREDGE & FILL No. 74244 A B C O
GENERAL PERMIT Previous permit#
New Modification ❑Complete Reissue El 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 I SA NCAC 0 7
❑ Rules attached.
Applicant Name DOLAAUAS Is /EQY�s Project Location: County 13 2u WSW 1 C r-
Address Street Address/ State Road/ Lot #(s) 117
CityState ZIP „yA —' 1 U N �n1 9 53 r mp-r
Phone # (33Q $ 52- - 1 S 21q E-Mail ,J 1A Subdivision Af IA
Authorized Agent LJANflj, 6" 1X%clr,- City 3EA 4-14 ZIP 2-9 462.
Affected ❑CW XEW )(PTA ❑ES ❑PTS Ac,>cN- Phone # [phone]q 5 River Basin��MBL' R
1-1OEA ElHHF ❑ IH ❑ UBA ❑ WA
AEC(s): ❑ PWS. Adj. Wtr. Body. Aiy,/�i_ (nat�unkn)
ORW: yes / no PNA yes / no
Closest Maj. Wtr. Body A I W W
Type of Project/ Activity 2£PL�A c E FL oA ; 1-,16% lam' ¢ c- Y- !X AmP
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A building permit m� be required by: �OL V r1� 6CA CIE ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions 07H, 1 ZOO 8r Aw- DrRci;L LJCA L. , 5TATr_ AAID
FEDERAL RFG LtiL_ATion/S APPLY,
I
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit'`
I moo 41 wo3
Application Fee(s) Check #
��Z_ Mc C1K1R-E:
Permit Officer's Printed Name ,
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Signature XZ
513 %2vI9 9/:5a
Issuing Date Expiration Date

It r LTIMA
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, 111
Governor Director Secretary
AGENT AUTHORIZATION FORM AGENT i �WA_ --ON FORM
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvada, III
Governor Director Secretary
Date: �/ l
Name of Property Owner Applying for Permit:
n d'A /'IC s
.S,o";r-K S
Name of Authorized Agent for this project:
fR/`/?A,1 6,R,'c.E�-'
Owner's Mailing Address: Agent's Mailing Address:
61
go Id gen 64FAV
2
Phone Number C 3.3 Y_5-�A — %.S'. 7 Phone Number L! f
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}:
.C/o 4 Ti fo �_, �r AC9 5
127 Cardinal Drive Ext, Wilmington. NC 28405
Phone: [phone] FAX: [phone] Intemek mm.nccoaslalmanagementnet
An Equal 0*orwrd1y 1 Affx=tNa Ac5oo Err kyer

T or my property located at / � /� /� . A 6-02-1 %� % , /7 a I l7—�l�} �j C �" 7 6 a
This certification is valid thni (date)
Property Owner Signa a date

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■ Complete items 1, 2, and 3. A.
■ Print your name and address on the reverse f
so that we can return the card to you.
■ Attach this card to the back of the mailpiece, B:
or on the front if space permits.
Article Addressed to:
I III' I'I IIIIII I II II �IIIIIIIII
9590 9402 2219 6193 1046 91
2. Article Number (Transfer from service label)
7017 0660 0000 7487
PS Form 3811, July 2015 PSN 7530-02-000-9053
❑ Agent
'_ ���� ❑ Addressee
by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Expresso
❑ Adult Signature
❑ Registered Mail—
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
tied WHO
Delivery
❑ Certified Mail Restricted Delivery
Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
El Signature Confirmation"'
❑ Signature Confirmation
0245 Restricted Delivery
Restricted Delivery
Domestic Return Receipt `

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: 1 t P&\ S� tC 1-32Q(t�
(Lot o treet #, Street or Road, ity & County) -
Agent's Name #: G—r icy �s�ru��lyt� Mailing Address:CG`ti1 `� 320Ch
Agent's phone #-. %0- tJ-�G q ��` � n �2 �,UA N( 2,6% i
I hereby certify that I own property ddjacent 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.
C- A description or drawinm with,dimensions, must be provided with -this lette911 r.
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. Correspo"&nce should be
- " mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represenim*" can also be
C contacted at [phone]. No response is considered the same as no objection lfy*&*"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
set ck, 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)
Signature
Print or e NaMe
h � n `J
Mailing A ess
City/StatelZip
Telephone Number
Date
(a
(Adjacent Property Owner Information)
J��
Signature
Print or Type Name
113 Pu--R6 ►T Di? -
Mailing Address
rAbrAP6-644c, �
A1,
City/State/Zip
336 --�?.q 7-1// 1
Telephone Number
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-- Date
Revised 611812012

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For delivery information. visit our
website
at www.usps.com
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COCertified
Maid Fee $3. 50
J
4 0470
$
` 02
Extra Services & Fees (check bay add ree e)
❑ Return Receipt (hardtop» $
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p
p
❑ Return Receipt (e ectronic) $
❑ Certified Mail Restricted Delivery S
ostmark' Z
O . HereAdult
P
p
Signature Required S
i
❑Aduk Signature Restricted Delivery $
�
Postage
$ $0.55 92
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Total Postage and Fees
$ 85
;Sent----- -- -1--- s---------
No.
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■ Print our name
y � Z and 3. A. Signature ■ Complete items f
and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece, B. Received by (Printed Name) C.
or on the front if space permits. 10
7. Article Addressed to:
1\4C Z<L)
❑ Agent
❑ Addressee
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
I I I III III II I II II I II I I II II I I I III I 11111111
IIII I I 3. Service Type El Priority Mail Express
❑ Adult Signature ❑Registered MaiITM
El Adult Signature Restricted Delivery ❑ Registered Mail Restricted
9590 9402 2219 6193 1047 07 ed Mall® Delivery
El Certified Mail Restricted Delivery %-:E tUrn Receipt for
❑ Collect on Delivery Merchandise
2. Artinla Ni Imhor /Trnncf e 4.— — In Delivery Restricted Delivery ❑ Signature Confirmation"'
7 0 17 0660 0000 7487 0252 Nail ❑ signature Confirmation
Nail Restricted Delivery Restricted Delivery
I (over $500)
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: �� l t�
Address of Property: ' t C� �� 1 —apc
(Lot o treet #, Street or Road,/City & County)
Agent's Name #: Gr ict (k RyNA a( l k3c) Mailing Address:lo�t� 3XAC\A D—
Agent's phone #:1\�nr 5�1q-gU(1,5 - e �W. N( 2-,646U
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 grawing the development they are proposing.
C AAncriabon or drawing with dimensions mtt kkith this letter.
5
si I have no objections to this proposal I have objections to this proposal.
ifIYU—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 representdtiv" can also be
contacted at [phone]. No response is considered the same as no objection fforave been
C notified by Certified Mail.
�y WAIVER SECTION
Vj 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, y u 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)
Signature
V)?�U C 1 ,ice@
`Print or Toe NaMe
1 � 5
Mailing AdWess
��k n �k( MO,
City/State2ip
l-`65Z-15Zq
Telephone Number
Date
(Adjacent Property Owner Inforr% on)
Sig ature
Print or Type Name
z i .s 4 8 4P1A17- Z-,r/
Mailing Address
City/State/Zip
Telephone Number
Dat
Revised 611812012

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Date Received
Date Deposited
Check Fmm Name
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit Number/Commenrs
Recei t or Refund/Reallocated
Column!
Column!
Column3
Column{
Columns
Column6
Column,
Column8
Column9
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#74244D
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