76272D - 16

LAMA / D DREDGE & FILL No. 76272 A B C
G E N E RAL PERMIT Previous permit #
)ONew --Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized bx 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
J /{ ❑ Rules attached.
Applicant Name ✓ " nl!'�/ �� LL C � Project Location: County 13 %/A gw ', c
Address �j2�-5 1,.� h ��c 4q—,4 � , a.� ~ad Street Address/ State Road/ Lot #(s)
City . .. State" ZIP Q 5 4 0 lcL `�,Gc... • •. o �. Jey
Phone # (", c.1a4-?E-Mail d^ iv.d j Q bc(j
�tSubdivision
Authorized Agent City0C[��5��
4JZ;k ZIP
Affected 2 SY%�f
❑ Cw FEW � PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (9�i dlG. (nat- /unkn)
❑ PWS: ' /
ORW: yes PNA yes , Closest Maj. Wtr. Body —A 11 w W
Type of Project/ Activity L0X4ce [� i tit, n -, r%s i21
ink (Scale: T S )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) 0
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore_
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length.
SAV: not sure yes -
I
Moratorium: n/a yes
Photos: yes _
Waiver Attached: yes
A building permit may be required by: .o �S)c tkc
( Note Local Planning Jurisdiction) �" /`
Notes/ Special Conditions � TLb r-- y t k�
Agent or Applicant Printed Name
Signature * P)Xe read Wpliance statement on back of permit
00
Application ee(s) Check#
❑ See note on back regarding River Basin rules.
.c, v,
Permit Officer's Printed Name
Signature
'314Zo2,o Z�td
Issuing Dati Expiry ion ate

AGENT AUT40RIZATiON FOR CA -MA PERK' 7 APPi-CA7)OV.
Marne all Property Owroef Reqoestong Pern*-
Makng Address
Phone Numeer:
ml AdCress:
i
L
ce#u-it r:(y gave auV,(Ytzed Agent Cvvra=
to act on my betial, for trie p"r;>GSe ot, appirig or anc of taiwv xl LAMA permits
f
necessary for ne tkowni aroma wyekornt--t OLO(J�-
-
I
at my prope!ty Dcale-- at
In
County
I furthermore certify that, I am aunt med to grant. and do in fact gfarul pemuss" to
Cwmop of CoasWVanag&twn* slat! pv Loca� Pomw Ofter and lbDjr agents "D enter
on the af6renwntioned :ands in connection mjh evaluatarg &-tfbmvtfbn , e!ated to this
peml appipcabon
Property Owner aformation:
be e YN t7e
PrW. or Typo,Vame
Ttus cemfi.cwton s vallic

�3ow ?# P. , �,. F = �i rd nko C K �t Lt �,�j{ tc t %� , r CA � W S C c
,Lot or swwas. or RoiQ Gty d ccuwl
*h * } 4 ^mow
MZy rie ca ez aC%Nv-'e -, of bo W' ors► oehrewod oroo � 7`* sv*wdiai
Pwff4 teas 0080-b�- 20 Ire as sXM on Pw al wohW 0-avff4L w *aveiWoM
thY wo aroPos V A d2KnWm M £ MMg vr- tir'7e wo—w m t VrM Mg nRMr
V _ :: ave no *ccuom to L"tjs pry". ; ?save c a1cVn tD ftS WDPoSdL
Ity" wo "oacsorrsrc rctsAsaaa $o. r cAo�►,�.c otCassa.e ��'a440
'are! �a oo+r3* of rae�t ora b soft* �a.� Mows a. mow ec a rf tsr+ia� An,r Rrs.
UNNOWA .002&d=-V L DM#WnM "+..wcvn 44MV Mtacrosr*dStOft 79d-7r ArcM"aaMIk
asaid�ss **am:w ao a4ircilar+I , .-JavT a'aA t y `iwtevc Mai
WAIVER SESTYJN
isw ON* qv)ardv pwop. areathalw. a0a#trae> A or atw mum ae w
Dark a rroulmm dvtwtm of 15 ftm wl roar of eipailml wows wdm gaited by im elf ya:
s to vmi%* Te tetacK you spocaipriaW t Ww t+ai m
' do not v4n to * ve try 15` semacx mgww%-;;.
Pmporty owrasr mformatim)
f= �w j 7 t o f
1
Prin txTj+�s6 1peln8 t33ra; tx aat — - —
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a t0�..i�►. Li/ it AidyrV*is
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Tei/tsav�r Airan�sr �''� itt = , `� a�pacn. ,
ore2cr.�

CERTIFIED M614 .- u RellI RECEjP RECIQE$TgD
DIVISION OF COASTAL N"AGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATOKPWAIVER FORM
Hama c;Property 0wrW._1(c
Aodren of Pmpep-
,,y:
10t cW Skeet #. thel or Rciicl, C&I A Oxo*A
Awnt's Nan* 0: Maw C
; hereby cetf) that I own p.-oWtY adjaCeint to the ab,-" reverenced Propefty. The i-xbvuju&
IRM" for thm pwn-,A ties descrbe�d 'o TO as Shown on Via e-tched drawing the de%40�?
'I'wi are PAMPO" A gglmptgn
IV— I ?gave r4 ob-lerns iD :'Ilis propou". �Nccio.0 to this proposai.
Y"j have owwftnx to V, P.M is beftio'c'.-.086d, MCS4
oo izr c-A-6-A-i 0--efte 0t,
WAOOPOOM, NCB 2UM3646 OCU rWn,&snftu,,u can tso be conameWat 0" 7W72-ts. mo nwpomo is
corwidwed the "-* - rM --1#bj*cV0n If you have bo&v no~ br CW~ftg.
WAIVER SECTION
uf'deWZnC that 8 Per dock. P&W, ty4qxWaW, wev--v3s. e, 0, -*Ilcin mav- be Se
back Mngntgn dWarce of I 5'from rcsy Gfee WIpMan W
w4.back. you musl MM jpteU Waived Dy:ne- Cif you
r to waive tre se'
back. SMOP11818 -Nanx below j
00 wish to waive setoacA re"pernent,
do not t*st, to waive the 15'sevmc� requjrq.-*.j_
(Pf011srty Owner Information)
AdjacOnt ftPOM Owner Information;
frIc nibs/
(%5j
signMure
Beth Whited Doby Whited
PaW or rW* mwo
PM orTyps kwv
I tA I I -- 111 1
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A*Wi?g Ad&ew
HOMW AddPoij
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336-214-0662 336-214-0535
2/24/2020
DOE
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CONSTRUCTION
PROJECT: 16 LAURINBURG, OIB (DOCK)
CANAL
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16 LAURINBURG LLC/DANFORD

Date Rocalved
Date Dp,,ftd
Cheek Fwn
Name o1 Permit Holder
Ktdar
Check Number
Check
mount
Permit Numberr/Commenb
Receipt or Ref—&Reasocaf d
Cohlmnl
Cdumm2
Cdumnt
C.1-4
Cok..5
c k—S
Column?
Columnd
Cdumn9
3/5/2020
3/5/2020
Lighthouse Marine Construction Inc.
Keith Moffat
Coastal Bank and Trust
3089
$ 200.00
GP #74861 D
JD rct. 10379
3/5/2020
3/5/2020
H5 Construction, LLC
16 Laurinbu LLC _
BUT
2480
$ 200.00
GP #76272D
BB rcL 10901
3/5/2020
3152020
William Mark Stanaland
William Stanaland
First Citizens Bank
2735
$ 200.00
GP #76285D
BB rct. 10905
3/52020
3/52020
F and S Marine Contractors, Inc.
John Murphy III
PNC Bank
8453
$ 400.00
GP #76250D
TMc rct. 9769
3152020
3/52020
F and S Marine Contractors, Inc.
HenryParsley
PNC Bank
8452
$ 400.00
GP #76249D
ITMe rct. 9770
3/52020
3/52020
F and S Marine Contractors, Inc.
PBW Development LLC
PNC Bank
8451
$ 200.00
GP #76248D
JTMc rct. 9768
3WO20
3/52020
Cohen Realty, Inc.
Robert Cohan
Uwhanie Bank
2054
$ 200.00
GP #76284D
BB rct 11474
3/5/2020
3152020
Robert A and Amy Cohen
Robert Cohen
Uwhanie Bank
10277
$ 200.00
GP #76283D
BB rcl. 11475
3/5/2020
3/52020
H5 Construction LLC
Mike Lopez
BUT
2479
$ 200.00
GP #76273D
BB rct. 10902
3152020
3/52020
Overbeck Marine ConstJDaniei ShirleyRobert
Lona Jr.
SunTrust
5309
200.00
GP #76247D
ITMc rct. 9766