72765D - Warlick

=_' C.AMAJ ❑ DREDGE & FILL ,kr7i°�NO. 72765 A B C
iENERAL PERMIT Previous permit #
JModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality X� / // �0
and the Coastal Resources Commission in an ar�a of environmental concern pursuant to 15A NCAC
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les a�`hed.
Applicant Name (��`' Y � r /� �'� Project Location: County
Address
City
Phone #'afo
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
❑ PWS:
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State 1� ZIPASIYO
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Street Address/ State Road/ I ot #(s)
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Subdivision
City ZIP_
Phone # /( `�"—"—"� River Basin
Adj. Wtr. Body A� A..r 4Z A1,, 6
Closest Maj. Wtr. Body ,y��-�"
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MEMEMEME
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Agent or cant Printed Name
x �Jq2�
Signature* Please read compliance state en on back of permit
Application Fee(s) Check #
PermitOf4er's Printed Name
Si ure "7j
Issuing bate Expiration Date

AGENT AUTHORIZATION FOR CAMA PEROT APPLICATION
Blame of Property Owner Requesting Permit: illJ�jitl C
Mailing Address: /d l / U y -P _
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ) n P'+► n e, V C� c.k .
►.,,��� rJ�rclL ►np„t
at my property located at�[n'�,� y 0 ,
in County.
I furthermore certify that l 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
Us
Print, or Type Name
6to. Ajsr
Title
Date
This certification is valid through I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to John D. Warlick, Jr. 's
(Name of Property Owner)
property located at 1028 Carolina Blvd
(Address, Lot, Block, Road, etc.)
on Sound Channel in Topsail Beach , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiorl,
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
Repair of existing pier and floating dock and relocation of boat lift as shown on
attached drawing.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.
do not wish to waive the 15' setback requirement.
John D. Warlick, Jr.
Print or Type Name
P O Drawer 1006
Mailing Address
Jacksonville, NC 28541
City/State/Zip
910-455-7700
Telephone Number/email address
Date
(Adjacent Pro rty Owner Information)
ignature *
James Summey, III
Print or Type Name
1222 Wood Lily Circle
Mailing Address
Leland, NC 28451
City/StateMp
Telephone Number/email address
Date *
*Valid for one calendar year after signature*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 'Taj � &I i� yl/�r /{^ 's
Name of Property Owner)
property located at %� /Y i ���i u �11yaL
(Address, ot, Block, Road, etc.)
on A oul� -e l in 5 / , N.C.
(Waterbody) If (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_-_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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' setback requirement.
Property Ow er Inform i n)
S,r�n.1/0
ure //)I j f,
JU L�' �/)r G ! C /�- ✓'
Print or Type Name
Zell So !4X
Maili g ,,a�dddress
C'y/State/Zi
Z -
Telephone Number/email address
7,79'/ 7r
Date
*Valid for one calendar year after signature`
(Adjacent Property Owner Information)
Signature
t 1. 1 I'A F r{ __ r.. ✓�
Print or Type Name—T— �—
h n o�
Ming Addre s IV C_.
City/ tate/Zip
,'I,4-633 -)R314
Telephone Nu ber/email address
Date ` - I
(Revise l Aug. 2014)

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Date Received
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