73540D - Terwee

C�jCAMA / ' DREDGE & FILL No. 73540 A B C
r. GENERAL PERMIT Previous permit#
6New ❑Modification ❑Complete Reissue ❑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 15A NCAC 0 ZOO
❑ Rules attached.
Applicant Name l7a.A$D TCi wce
Address 530E l UAJCr-cx-Q WA\f
City ZAI G I GN State )• C ZIP 9- G(
Phone # ('110 ) 443 0812 E-Mail N A
Authorized Agent 7E1.:> j-&L,,AS - CA,(tw,11Er2 A.AAat►.,E
❑ Cw
p EW '- [A PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑' OEA
❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes /
PNA yes /60�
,n�
Project Location: County
Street Address/ State Road/ Lot #(s) I ��
Subdivision
City Oc'r-A�'J tSL- ISEAC N ZIP ZSY(i
Phone # (` 10) L(!13 LJ ft9 River Basin r! ,-,3C It_
Adj. Wtr. Body C-As cr(L n/ (4A &w c L (01man /unkn)
Closest Maj. Wtr. Bodytw W
Type of Project/ Activity Ci w'-)QaL T 177, K60) L- JJ(:A6 pL k Fu(LM AT CNN i )F r?tC-fL
(Scale: 1" . Z p' )
Pier (dock) length
Fixed Platforms) A
Floating PlatfJoffshore
Finger pier(s)
Groin length
number
Bulkhead/ Rip
avg distmax disBasin, channe
cubic yards_
41" ramp
Boathouse/ Boatlift
Beach Bulldozing_ 1
Other —
ow
ow �1 �► z
Shoreline Length
SAV: not sure yes 4:9)
Moratorium: 6,D yes noIsm T
Photos: yes n _I I aw 4V
Waiver Attached: no
1
A building permit maybe required by: Tn\-'N OC OCEA-J \ SLE UAL M ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions AtL CUNt�It�oNS of c��N_13(�fLncw��jr�TE ia..,(� �F�l RAt Q.Ft, k-Allu'­S PPprlL\l.
CunlF\Yrl7 Pt.ATFi)ItN WIl4 NuT iF RUIIT avER rriAS;na.-rlAwi)S
❑� te(\+
Agent or Ap 'cant Printed Name
Signature "Please read compliance statement on back of permit"
Z Zc)y #- ( 2.30
Application Fee(s) Check #
Permit Officer's Printed e
Signature
7/ 1
Issuing bate Expiration Date

AGENT AUTHORIZATION FOR CAMA PERM APPLICATION
Name of Property Owner Requesting Permit: E _i(F/z WEB
Mailing Address: -5-90 j'✓C) YYA
Phone Number:
Email Address:
I certify that 1 have authorized /6-p
Agent / Contractor �Q.�✓STiPv�7iaVIV
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _
rq D.D 5=a�Aj6- A A A N D C" _�a c t
at my property located at 12 c� \-/ -3 TP 011 ,
in County.
I furthermore certify that I am authorized to grant, and c'o in fact grant permission to
Division of Coastal Management staff, the Local Permit r ":er and their agents to enter
on the aforementioned lands in connection with evaluwn :.; information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Ow net -
Title
-5
Date
This certification is valid through I I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: C'( ✓C�Yc� e Q
Address of Property Z� W 2S3v� (���
P
(Lot or Street #, Street or Road, City & :,ounty)
Agent's Name #: z r P, 1 n Mailing Address: i L A h i
Agent's phone #:
J
I hereby certify that I own property adjacent to the above refu anced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing.
-- 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 die Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp•//www nccoastalmanagement-net/web/cm/staff listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have then noted by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requnt.
(Property Owner Information)
�J Signature
Print or Type Name
Mailing Address
po ivy`
City/S ate/Zip�
C1 9 L-¢3 - I -i
Telephone Number/Email Address
Date
(Riparian 'roperty Owner Information)
Signature
C Aq-,) ( P__ ��
Print or Type Name r
vJ S
Mailing Address
City/State/zip
Telephone Number / Email Address
Date
} (Revised Aug. 2014)

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DMSION OF CO OWNER NOTI ',ATIONJW
-MENT y AIVER FORM
ADJACENT RIPARIAN PROPERTY
Name of Property Owner
Address of Property: (Lot or Street #, street or R,46 & County)
MailingA. dress: 1 t L' a, ; h;
Agent's Name #: y ��
Agent's phone #:
t hereby certify that I own property adjacent to the above referenced property.
The individual
applying for this permit has described tome as shown on tt�F attached drawin the develo ment
they are proposing. t :"
I have no objections to this proposal. I have object ons to this proposal.
o✓L5 uv (eeo T� 0.� 2,� ✓ I Mana�emjent
_ de " O sed ou must hoft the Division of Co�sfa 5_
ff you have objections o what is being propo , Y is
(DCM) in writing within 10 days of receipt n�of net/web/cmist is notice. �' b� oi ict information
b acalling 1 DCM
4RCOAST
available at h J/www.nccoastalmana >F.en notified b Certified Mail.
No response is considered the same as no ob'ection if ou h-
WAIVER SECTION'
boat rarr; � hrear Nater, boathouse, or lift must
I understand that a pier, dock, mooring pilings,
A � area a Sian access unless waived by "me.
be setback a minimum distance of 15 from my_ - o ,ate blank below.)
'you wish to waive the setback, you must initial the ap, p
I do wish to waive the 15' setback requires , , ant.
1 do not wish to waive the 15' setback requirement.
(Riparian Property Owner Information)
(Property Owner Information) _' /`'
Signature
Signature
i P, Print or T► ne Name
Print or Type Name r o g t (:9A4J
y ` Mailing ;ems
Mailing Address f C)-
-Sz kJ : K ! C_ � �, LJ C; 'StatefZ,)
City/S ate/Zipf _
Ci K � 1 4 } 7 .:le�,hone Rlumber /Email Address
Telephone Number / Email Address
Date Date (Revised Aug. 2014)

CgRTIFIED MAIL ETURN RECEIPT REE
DMSION OF CO��ER�O TA���RFORM
NTpjpARL4,N PROPERTYV-
ADJACENT
Name of Property owner.
M
Address of Property: (Lot or street Street or k0a* & County)
MailingA- dress:
Agents Name
Agents Phone 01
property adjacent to tie above referermed propy.heindWualI hereby certify that I own to me as drawi�nt
applying for this permit. has described
they are proposing.
I have no objections to this proposal. —1 nave objec - ms to this PrOPO-W
.�1 — . ego 0 g avo& o-A ef = M%A is I ;4bac�
fhaAje 01%?ZIJI�15 dwe hodfy do &VAJOR 01 co" UW09"0,4
I Cor, jGt hownwom for DCU
ff you have o*cdons what is befog Is
(DCU) in Wdft Wifti 10 dayS Of MOW Of dds notice- -s884RC0AST-
emerr�neth��A- ftgorbya~
avagableathMham n~byqW~-AftLL
WAIVER SECTIO"'
mooring pilings, boat rarr,-, brea,, cater, boathouse, or lift must
1 understand that a pier, dock, I .an fxx;ess unless waived by. me. (if
n
be set back a minimum.distance of 16 froM MY -a nA- - ate blank below.')
'you wish to waive the setback, you must AnItLal the pprup ant. Q 3,4
MINNOW I do wish to waive the 15' setback requirei,
j
I do not wish to waive the 15, setback requirement.
(property owner Information)
Signature
QL;�:Tvn �m
Print or Type MG
Z-21
Marling Address
14 LP
Lf L43 - (4,? q
. .......... . . ------
Teklwphorm Number/Email Address
property Owner information) (Riparian
Sig"wure
Print or Tvne Name
t naz— -LA#,j t cow
AJ C-
- StatWI-- . d
TAelhone NumOv! I'Emaff A
RAF
IV=n
Dare M WILMINGT�N,
(Revised U9. �b94
J U N 13 2019

i
'7090
zso
-jj
g-am a -
Itad
')N� �
wA o��

Date Received
Date Deposited
Check From Name)
Name of Permit Holder
Vandor
Check Number
Check
amount
Permit Number/Comments
Receipt or Refund/Reallocated
Column)
Column2
Column3
Column)
Columns
Columne
Column7
Columnfl
Column9
7/3/2019 7/3/2019 Backwater Marine Constr/Ted Helms
Gerard Ter Wee
BUT
1230
200.00
GP# 73540
TMc rct. 8752