69343D - Christiansen

I LAMA / DREDGE & FILL
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4ENERAL PERMIT Previous permit # A B C
Clew _.Modification ❑Complete Reissue CPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources (1 �.� (fu et
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC n rj u J
Ruled attached.
Applicant Name Project Location: County -
Street
Address 1 Address/ State Road/ Lot #(
City tiV, �'i(� oi4w Stat ZIP
Phone # (" V)V -Mai Subdivision `�
Authorized Agent 1 C�� City ^Y' ZIP_
Affected ElCW Nkw A ❑ Es ElPTS Phone # ( r) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 1
❑ epllS: nl
yes ORW: yes rno PNA / no
Closest Mai. Wtr. Body
Pier (dock) length A
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tr Applicant Printed wime
ignature "Please read compliance statement on back of permit �* ,
Pplication Fee(s) Check #

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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date I'- /-�,
Name of Property Owner Applying for Permit:
o---
Mailing Address:
2v L--,
Alt-e� Nkr;Ae )
I certify that I have authorized (agent) _I J h le /`I "A Ga ^� C-�'r"to act on my
behalf, for the purpose of applying forandobtaining all CAMA Permits necessary to
install or construct (activity) I v �� ^� "l D ��' ,
71
at (my property located at) 160
This certification is valid thru (date) I l
Property Owner Signature
�-lg -1 -7
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 1 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to l S r, 3 x Seer is
(Name of Property Owner)
property located at 36 C 5- 10,a444er L,, -
Block, Road, etc.)
✓1/L
on h., ,, 64ek , in fiel-I 2!` CO , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
--------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
qZ-
Mailing Address
otic- 28KN)
City/State/ ip
Telephone Number
(Riparian Property Owner Information)
Signature
Print or Type 114ame
Id -4f73 3(76
Telephone Number
7� - ao 17
Signature Date Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to I 6a 01/13 f2 5R--1 's
(Name of Property Owner)
property located at
3(.() S . 14, �,
(Lot, BIA, Road, etc.)
on J to r Vt A- 6/- 2 , in �e.� �i co - , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and,1
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
f
m . (If you wish to waive the setback, you must initial the appropriate blank
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fdled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address d`L
NG
City/State/Zip
quo 3t, 7
Telephone Number
ll� 7 �3l-17
Signature
Date
Telephone Number
Date

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �, U y� G) J `�'�J
Date:
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excludes any
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impactamount
temp impacts
amount)
C)\N
Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
2�

WIRO
Date Received
Date Deposited Check From Name
Name of Permit Holder
Vendor
Check Number
Check amount
Permit Number/Comments
Reea/pt or Relun.Real/oeatetl
8/4/2017
Sheffields Seafood & Grocery Inc
John or Wendy Sheffield
First Bank
9028
$400.00 GP 69289D
SF rct. 4670D
8/4/2017
William or Lillian Bright
Same
NC SECU
1026
$400.00 GP 69357D
SF rct. 4611 D
8/4/2017
Elizabeth Easley Wetherill
George Brake
BofA
4627
$200.00 GP 4608D
SF rct. 4608D
8/4/2017
F and S Marine Contractors
Susan Gross
PNC Bank
6475
$200.00 GP 69362D
CS rct. 4600D
8/4/2017
Allied Marine Contractors/Hal Fogleman
Todd Christiansen
First Citizens Bank
5831
$600.00 GP 69343D
TM rct. 4645D
8/4/2017
F and S Marine Contractors
Craig Goess
PNC Bank
6487
$200.00 GP 69378D
CS rct. 4753D
8/4/2017
Coastal Marine Piers Bulkheads LLC
Gerald Hayes
Wells Faro Bank
21575
$200.00 GP 69361 D
CS rct. 4599D