72717D - Stroupe

b,V.,27 XCAMA / XDREDGE & FILL
' GENERAL PERMIT
XNew ❑Modification El Complete Reissue El Partial Reissue
A B C
Previous permit #
Date previous permit issued
No. 72717
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 % H . 11y O
❑ Rules attached.
Applicant Name !D>=t1 N `S'Tk 0 u P 1± Project Location: County -9a L& NS w I c ►c
Address P 0 130X 9 1Street Address/ State Road/ Lot #(s) 3 11
City MT Now-v State X-C 281-2o S'roKr;=s -DR WF_
Phone # (704) V22 - 4000 E-Mail dnS�rouj�e�s�rou�telco�;c,corSubdivision /J /A
Authorized Agent C (210E CoPIST I4uk0-r%o/y City 4uM5-rT tie nc H zip 2?4 6 E
Affected XCW ❑EW El PTA JXQES )JPTS AGrr/-r Phone# (qlo )51y - gogr River Basin /—twoEr—
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA El N/A Adj. Wtr. Body R-r j_F C Rrr K na /man /unkn)
❑ PWS:
�wanc�Ct �
orApplicantPrint _ e
V\1- / l04
Signature ** Please read compliance statement on back of permit **
$ 400 4127s
Application Fee(s) Check #
►V -A M -C6;ulaF_
Permit Officer's Print Name
Signature
2/& /'-7
Issuing Date
& /& /20,9
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ^,n.-h+i✓ y, S
Mailing Address:
/'00 J ox /'?
Phone Number: %�/- '9.22- yo0a
Email Address: "J 7;eo � - ram►
I certify that I have authorized GsNku J "6R
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits /
necessary for the following proposed development: J, << 4r o �4 c C
rnL
at my property located at 311 zD-
in County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer, and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
p 4j,lE l --
Title
1 '? l//9
Date
This certification is valid through �-- I /' V

19
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
Name of Property Owner:- ��G ►'\ vk'.f�C
Address of Property: -611 S
(Lot or Street #,
Agent's Name #: Gr ICt � V)*LtJi6o
Agent's phone #: %o- s-n -qua5
or Road, City & County) ---
Mailing Address:WaQc\-\ D_ 3W
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 deW
sscription or drawing, with dimensions, must be- mvided with this letter.
1 have no objections to this proposal. I have objections to this proposal.
tf youhave 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-, 1VO; 28405-3845. DCM representativos can also be
contacted at [phone]. No response is considered the same as no objection if you 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.)
� ��= -- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setbac requirement.
(Property Owner Information)
�a�AnNd Cq�1CA J
Signature
n Si
Print or Type Name
Py 3 1
Mailing Address
City/State/Zip l
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Telephone Number
Dale
(, scent Pr y Owner Information)
Signulvre
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Print or Type Name
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-Mailing Address
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City/State/Zip
01 to
Telephone Number -
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Date
Revised 611812012

■ 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:
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A. Signature
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B. Recei d by (Pri fed Name)
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D. Is delivery address different from i
If YES, enter delivery address be
gent
❑ Addressee
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? ❑ Yes
❑ No
Service Type
El Priority Mail Express
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❑ Adult Signature
❑Registered MaiIT^'
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
9590 9402 2219 6193 1035 64
t-certified Mail®
Delivery
�j Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
2. Article Number (transfer from service label)
❑ Collect on Delivery Restricted Delivery
red Mail
❑ Signature ConfirmationTM
❑ Signature Confirmation
7017 01360 0000 7487 0535
red Mail Restricted Delivery
Restricted Delivery
r $500)
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
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rt Extra Services & Fees (check box, add fee are/
❑ Return Receipt (hardcopy) $ f
1:3 ❑ Return Receipt (electronic) $ so (10
O ❑ Certified Man Restricted Delivery $ $ r
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1: ❑ Adult Signature Required $
r-3 ❑ Adult Signature Restricted Delivery $
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$ #b.70
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❑ Return Receipt (electronic)
$
$ $0 . 00
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❑ Certified Mail Restricted Delivery
$ $ 0 - 1i110
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❑ Adult Signature Required
$ 0. .00
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Date Received
Date Deposited Check From Name
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit NumberlComments
Receipt or Refund/Reallocated
Columnt
Column2 Column3
Colu-4
Column5
Columns
Column7
Columna
Co1umn9
2W201
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'GP #771
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