76228D - 304

_�,CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
XNeW --]Modification ❑Complete Reissue El Partial Reissue
No. 76228 A
Previous permit #
Date previous permit issued
C
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
C /a M 1 C NA E L T AV IS ❑ Rules attached.
Applicant Name 3a 4 WA-r1<Iz STREET LLC. Project Location: County Nr-vi i .AwoyER
Address j 19.1 M I L T TA R v C L-kT o F F R o Su rm 31 4 Street Address/ State Road/ Lot #(s) 3 O 4
City WIL-MWCiTOn/ State A/C ZIP 2 MoS' WA j E R '5TIZr-T—T
Phone # 010) 2'27- 2239 E-Mailri±U�Vi3 ®uua�io„�Psearch.,,,5ojbdiv1isiion '//A
Authorized Agent TM 1A �1Wt/orzTA City R lGla I SV I LLE BF-Ac N ZIP 2 d4 910
Affected ❑ Cw XEW %PTA ❑ ES O PTS ACC wfPhone # (q 10 ) 2 31- 95 4 River Basin wN IT£ C'AK
AEC(s): L1 OEA ❑ HHF ❑ IH ❑ UBA ❑ WA Adj. Wtr. Body 13'wK S CNA.v v E L nat man /unkn)
❑ PWS:
ORW: yes /� PNA yes / o
Closest Maj. Wtr. Body ORCE-ivILLE So.L./D- A 1WW
Type of Project/ Activity J S i AL_L. Doc V_ To Cx I STI Ale,
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A building permit may be required by: Iyv FR 1 C.N i 5V ILLS fr-AC" ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions f4,AX l m%& m oo f Two (X Z) roR MA t-1 Z C D ILAT S I-i PS A,(- "oR M_D,
Na, P/IRT OF THE D6r_g,,wG Filc#LtTy S ALL- £XcEED 7F4E TOWNS ESTASc4SMcD
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit **
SZc o -4f-2322
Application Fee(s) Check #
A c 61A IRE
Permit Officer's Printed Name
c
Signature
2 A
Issuing Date Expiration ate

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 41 64 cz-\ (M�j S
Mailing Address:
Phone Number:
Email Address:
'-)CVn6) -- C(1�7- orla 3q
VS
on
I'l
I certify that I have authorized
Ag nt / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
C-
at my property located at .�O �-/ LI) a�c,. Sq_ Gar:
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 Info ation:
Signa re
Print or Type Name
Title
/ %(J - /OC&O
Date
This certification is valid through

ADJACENT RIPARIAN PROPERTY OWNER STATEML NI I
. j 9
I hereby certify that I own property adjacent to 1 '< 1 1u --
' (Name of Property Owner)
property located at '� C' ` / � �� ( I � � � ' k �
(Address, Lot, Block, Road, etc.)
on h�� 11 >, .,, r� in e (�.t 1, ; �C �r. l N.C.
(Waterbody)T(City/Town and/or County)
The applicant has described to me. as shown below, the development proposed at the above location.
X 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, 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.
x I do not wish to waive the 15' setback requirement.
(Props ner Inf
Si nalwe `
sCdt�� `�Cw✓ 5
not or Type Na e
�� qLr
(1J�n8 �
t�►CSV
ci t Ip
o - as-r--aa
Te/e hone Number Qv
Dale
"V esley M Carter
Pint or T
306 idea er t
Mading Address
Wriahtsville beach
clty�state2p
41Q-612-8900
Telephone Number
_ 0211 12020
Dart
(Revised &Y 2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l'l 1c e I T"GJ, ; s
(Name of Property Owner)
property located at 3C)
�) (Address, Lot, Block, Road, etc.
on J L- in ( ' , c •C( S , //� 1 e-c C 1, N.C.
(Waterbody) (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)
,Sf t- c? 4 C
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' setback requirement.
(Property 7ner Info )
Si at�(re 1
C�a1- � (6� ,5
Print or Type Nape
32 �L er
Mail n dss
v� reV i�
ci t e2ip
�) - r 7—o-a39
Terhone Number
b � Sao
Date
(Adjacent Property Owner Informa
. n)
L , ko 6�s
P/l!nt or Type N e 4C L
Telepho e umb r
Date
NG
(Revised 611812012)

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