72716D - Sunset

.V2 XCAMA / 'X DREDGE & FILL
LGENERAL PERMIT
No. 72716 A B C
Previous permit #
N
XNew Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality o
and the Coastal Resources Commission in an area of environmental concern purspant to 15A NCAC n7 i't j j OO & 12 O O
,' c% F t T T y ❑ Rules attached.
Aw
Applicant Name �S fANSET y'EW 1 H%C . MP-< A" Project Location: County FR V N5 W I c K
Addre'ssr 2890 Sr. CLAIRF_ Rv
City W I NSTOA/ SALE M State_ {V C ZIP 27 / C)&
Street Address/ State Road/ Lot #(s) 1 & 15
CANA L DRI s
Phone # (3:%) 7G5 - 883 3 E-Mail %d uIRS
lick w rQ m;,1ASpri„W
Subdivision /V 1A
Authorized Agent 6 R I C C CO.JSTIttXCTIOA/
City Si BEAC N
ZIP -7-eT46 T
gcw XEw j(PTA )(ES
XPTS AGra/-r
Phone # (q I o) 579 - `10 Y 5
River Basin I_tt Mrr R
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA
❑ N/A
Adj. Wtr. Body AYAAI-
n t ma unkn
❑ PWS:
Closest Maj. Wtr. Body /
S cREt=K
ORW: yes /® PNA yes/ 0
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LEFT
A building permit maybe required by: --TS /A/ CF 5"A/.srr 13EAC—R . ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions 07 (i . 1100 & 12.00 AND ALL OTA£ 12 LOCAL _ STATF .
A14D FEDr-iLAL Rr-GIALATIO/JS APPL)/ IAPLAND �+5-ro,wp,AWr-r-s Ftz,-,rA
P—, ✓i\c AT -12'Cr AI ArrLA l.r L/MlTrzr% Tim 2 0 / / AvT)LJAt2-%")_
Agent or Applicant Printed a e
Signature "Please read compliance statement on back of permit"
0 (Poo # 12 758
Application Fee(s) Check #
MC Gu ►QE
Permit Officer's Printed ame
c 40zt
Signature Or 2�14�2 o1g %I4 12019
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner- Requesting Permit: s
Mailing Address:—
Phone Number:
Email Address:
I certify that I have a
R ` 3-------
-- Agent i Contractor
to act on my behaffr-for the purpose -of -applying for and obtaining all CAMA permits
necessary for the following -proposed development:
--_ at my property located -at
Cc_JCCYLCounty. --- ---- __-- -
4-furthermore certify that 1 am prized to grant, and do in fact grant permission to
Division of Coastal Management -staff, the -Local -Permit -Officer, and theragents ts-enter
fie aforementioned lands in -connection with evaluating information related- to this
permit application.
Pr9perty Owner Information
Signature
Wint r ype Name
TMe - ---
a e'er
rK
This certification is validt�ugh I 7= 0 00 rVVlic 0 —
I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: Q IS C �a t✓ f3auA
(Lot or Street #, Str et or Road, City & County} --
Agent's Name #: Gr ict C� r,5yrLtc it 1 Mailing Address:66M 62aLh D(-"
Agent's phone#:����rJ�Ci'gb9n�C11 �� ���4q
V� 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 drawin the development they are proposing.
FINEENSUffamm Mar
si 44i-rl
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 Div/ n of Coastal
r Management (DCM) in writing within 10 days of receipt of this notice. Corres a should be
—T' mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represe can also be
contacted at [phone]. No response Is considered the same as no objection /tW**been
C 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 _Myarea 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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Pro
�Ow�nerJinformation)
Si nature ESig alure
\ 1;
o K /a s 4\
Print or Ty nt or Type Name
5\.- N, . I C �', 1k
Mailing Address
Uikc,s�� St\e.nt NC 214
City/State/Zip
Telephone Number
Date
!G l3 C, C,a. I �) r.
Mailing Address
'SU tAs Lt-+ � Q�/l
City/state/Zip
glD�00-
Telephone Number
Date
Revised 611812012

Domestic Mail Only
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SULUMT
c:O Certified Mail F
x3.45 i 147i i $ Fee �
N Extra Services —Fees (check bar, add tee �ppgopgate) 1 `r
❑ Return Receipt (hardcopy) $lt . L�rJ
❑ Return Receipt (electronic) $ Sri _ no Postmark
❑ Certified Mail Restricted Delivery $ tHere
C3❑Adult Signature Required $
❑Adult Signature Restrcted Delivery $
C3 Postage
� f1.1,50
.� $
Total Postage and Fees
121071201
C3 $ $6.70
r- Sent
C3 r et PSI N o PO Box
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■ Complete items 1, 2, and I
■ 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: �� 1
2J '
A. Signature f ( I v�
l ` — �O Agent
❑ Addressee
�Zeceived by ( anted Name C; D e of D Ii
D�Is delivery Jddress different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
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IIIIII1I'IIIIII II 'I III II�III I i 3. Service Type ❑ Priority Mail Express
❑ Adult Signature ❑Registered MaiIT'^
❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted
9590 9402 2219 6193 1048 44 AgiCertifled Mail® Delivery
❑ Certified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
ir•la Ni tmhar ffransfer from service label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation
2. Art — - - - ❑ Signature Confirmation
7017 0660 0000 7487 0832 trietedd Delivery Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053
Danestic Return Receipt

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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:
�S
2-310
9590 9402 2219 6193 1035 02
A. Signa t
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❑Agent
❑ Addressee
13:j3eceived by (Pri d Namea I C. Date of Delivery
D. Is delivery hddress different from item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type ❑ Priority Mail Express@
❑ Adult Signature ❑ Registered Mail —
El Adult Signature Restricted Delivery ❑ Registered Mail Restricted
ertified Mail® Delivery
❑ Certified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
2. Article Number (Transfer from service label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation''"
❑ Signature Confirmation
7 017 0660 0000 7487 2201 estricted Delivery 1,3estricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
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For delivery information. visit our website at �-
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❑ Return Receipt (hardoopy) $ VV ll�rlt�t
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❑ Return Receipt (electronic) $ • I
Postmark
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❑ Certified Mall Restricted Delivery $ *n _ 0�yn
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❑ Adult Signature Required $ $0.00
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❑ Adult Signature Restricted Dellvery $
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Postage $ 0 . SO
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12/07/2018
Total Postage and F.ae. 7�
7sO0
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