72779D - Stovall

k-06-rA t>,AV . 1-1
rCAMA / ❑ DREDGE & FILL -rM MOOIFIs-V
�. GENERAL PERMIT 3/25/1"1
lew XiModification Complete Reissue ❑Partial Reissue
No. 72779 A B C
Previous permit #
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
❑ Rules attached.
Applicant Name 908C ILT CILilk 45MYAl l
Addressc:,X1' -1�7
City State__ZIP :7S'1�
Phone # ( 504 - 2 4 71 E-Mail 'Al
Authorized Agent CgAa.1_,Fs :D_,Cr. ,icy-rµ
Affected ❑ Cw `A'" C)LPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ I
ORW: yes / pi PNA yes /
Project Location: County Oa .'J ALS wsC 1r
Street Address/ State Road/ Lot #(s) ( 9 13
0 A V N AR 13-WDiL sip
Subdivision N /A ('OA1- AA R S o R ll
City OCrA.W _1 ey-AC►.1 ZIP 21?4&1
,A&f� Phone # 1 3 L 39 - 9 79 N' River Basin L-VM
Adj. Wtr. Body ,A I WW 14 nat /ma /unkn)
Closest Maj. Wtr. Body A 1 W w
514
Groin length
number
Bulkhead/ Riprap len
avg distance offe
max distance offsho
Basin, channel
I
18V
I r
II II
lm
OO\fi
y �f
/! i1 pyTi
cubic yards
Boat ramp
Boathouse/ oatlift
Beach Bulldozing
CUP
her RAMt� 3' x Ilo'
OWr IZB�'.4Z -
&Z-66c, 8'
Shoreline Length 0 ,
SAV: not sure yes
Moratorium: rO yes no
Photos: yes PC
C
Waiver Attached: Perylby:
1 1 I1 p't_AI WAF- MAK14mY &rm WIlVI 1 111 11 1 1 11 I/Ivl
A building permit may TOWN Di= f�eEAnf =Sr- &MC% ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions 07 [1. IZ O0 "D ALL OTNKJ? L^CAL _ S-rA-rr_TA AID
FFnF_91AL illki/S APPLY- 9T&ikeX1l Mtx-g-r Alnr SAieIgo Ac-w
Q^i t_ _ . n.,- C7 -
('x �4ye_-S At'(_/{ C, ) 6 '- ' N
Agent or Applicant Printed Name
Signature ** Please read compliance statement on Please read compliance statement on back permit permit
'#200 409 OS40403
Application Fee(s) Magr-y QjtW4,4 #
Y I.az. 4 IA 1177C
Permit Officer's Printed Name
Signature
;/. iA c
;Z1I Z f2O 19 ( 11:ZAOI9
Issuing Date Expiration Date
N11�01F1�o 25/Zo19

��A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: `
Name of Property Owner Applying for Permit Name of Authorized Aunt for this project:
o � 5fovtLL
Owner's Mailing Address:
-_15k / l- `%
;�0X 45OW0 Al a7s"�j
Agents Mailing Address:
Phone Number 0; Phone Number (5?6
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 / qx 1714Ar
This certification is valid that (date)
Property Owner Slgnatw Date
127 cardinal Drive Ext., Wilmington, NC 28405
Phone: [phone]\ FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity\AfNma6ve Acton Employer
Ncj! hKarolina
Admallll

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICATION/WAIVER FORM
Name of Property Owner, e 10 ///
•L �
Address of Property: /J/
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #: 3 6
Mailing Address: /9/� ol4k
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.
C1 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you mustnotify 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, 26405.3845. 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 the setback, you must initial the appropriate blank below.)
//k- L.— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
y 13
Print or Type Name
ety
Mailing Address
Cify/ atefZip
So e-1 _ �24 7/
Telephone Number
(Adjacent Property Owner Information)
Signature
Print or Type Name
lyl`17 Oak 4aior �� S
Mailing Address
cityrstateizip
.6- 70 -_,27�
Telephone Number
Date
Revised 6/18,,2012

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at /f_ a/q �1%z ,-4940
(Lot, Block, Road, etc.)
on in N.C.
(Waterbody) (Town and/or Coutity)
Applicant's phone #: O-Nailing Address:_ x 11,52
�Q?� c31Je D N� � j's73
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
7 //S 7
Mailing Address
Wo
City/Statelzip
336 -
Telephone Number
Z
4,-�gure Date
--------------------------------------------------
(Riparian Property Owner Information)
/ `Signature
171 411 d/127 nu L i`irSi
Print or Type Name
Telephone Number
Date

14
rvt
Pit

Date Received
Data Deposited
Check From Name
Name of Parmit Holder
Vendor
Check Number
Check
amount
Permit Numbed Comm fs
Receipt a RefLH MMllocafed
Columnl
Column2
Column3
n4
Column5
ColumrM
Column7
Columns
Column9
2

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D/B
J
5
a
3IZ41,1y
411
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