69215D - Carros

?CAMA / `.❑ DREDGE & FILL CQ ij`�i bs �� 1�1 A B C D
GENERAL PERMIT Previous permit# 0
�*levv —Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
El Rules attached.
Applicant Name ((U ir^t r L Project Location: County on
Address ` V lw 00 J Street Address/ State tRoad/ Lot #(s)
City 'i>�r S�'A StateNC-ZIP
Phone # O ar iiJU� E-Mail `—__.__.__ Subdivision /
Authorized Agent �,J►"iQ tv�_ City'�a ZIP
[[��[[ a Q /,�15
i
Affected ❑ CW *A ❑ ES ❑ PTS �PFiohe # ( I v) 1_ 1 V ' Rive Basin tym t
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body C CL V (nat / /unkn)
❑ PWS:
ORW: yes / do PNA yes / �o Closest Maj. Wtr. Body � ✓�
Type of Project/ Activity FAMORA W, PA I
��•
■■■■■■■■■�,�w■w■�■■■■r:�:�:w■■■■wr�■■ww■� wry
■ lip ■ME
■■■■■■■■■w.■■ ,inn■r-s�!��
■■■�■wow■■■.■■■■■■■■■■w�■■ww■I�w■uw��
Boat ramp
Boathouse/ Otl'li
l
Beach Bulldozing
Other
■■w��i�r■■■■■air■��r�r�ux�w■■■■��■�i�ucrL�■�,����■�
0 ONE
t I
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Agent or Applicant Printed aml�)
u
Signature * Please read compliance statement on back of permit*
�00.0�
Application Fee(s) Check #
7

WIRO
Date Received
Date Deposited Check From Name
Name of Permit Holder
vwwor
Check Number
Check amount
Pernik NumberlCommerns
Receipt or Retund/Reallocated
5/26/2017
Gnce Construction
John Parker _
BB&T
112471
$200.00 GP 69214D
SF rct 4250D
5/26/2017
Gnce Construction
William Buck
BB&T
11248.
$200.00 GP 69216D
SF rct. 4251
5/26/2017
Gnce Construction
James Carros
BB&T
11249
_
$200.00 GP 69215D
_D
rct. 4252D
5/26/2017
Donald or Carol Ewing
same
NCSECU
_
6848
$400.00 GP 69213D
_SF
SF rot. 4253D

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: 5 / ``-V
Date: /�
Describe below the HABI AT 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)
impact amount)
temp impacts)
amount)
Aj
Dredge ❑ Fill ❑ Both ❑ Other
bl
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Pat McCrory
Governor
WIXNR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Braxton C. Davis John E. Skvarla, III
Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuKm
Date:
Name of Property Owner Applying for Permit: me of Authorized gent f r this project:
k ri
Owners Mailing Address:
Phone Number
k9ent's Mailing Address:
Phone Number R
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtai�nins all CAMA Permits necessary to install or construct the following (activity):
For my property located at
This certification is valid thru (date) \ L Q�'\-N-\ k�y
Property Owner Signature
Date
127 (,dual DrW Ext, ffdtningtw, NC 28405
Phone: [phone] FAX: [phone] Internet: wnv v_nuoas alanarag?tnent.net

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: On -es Co r r�z
Address of Property: ((Lot or Street #, Street or Road, City & County) `
Agent's Name #: v ` Qk ACZ.IC\)n Mailing Address:
Agent's phone #: ` S-1 ' `I Q LS z v9-
I hereby certify that I own property adjacent to the above referenced 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 the DivI ' n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspe should be
�► mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3846. DCM repres4; can also be
contacted at [phone]. No response is considered the some as no objection abeen
notified by Certified Mall.
W WAIVER SECTION
V) 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.)
d 1 do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
G,
Signature
Jgr
Print or Type Name
�y 'V%Q1( CV-" V)- %\(-.P
Mailing Address
Zvi 1� SC 2�(DO
S
City/State2ip
,a% --IL q-\(01SS
Telephone Number
y-7s-\'}
Date
(Adjacent Property Owner Information)
Signature
ILI.s�rS T ,ZC�,((P.n
Print or Type Name
o2'y� n�n� �Jr•
Mailing Address
City/State&lp
- 02. y0
Telephone Number
- ZZ
Date
Revised &18/2012

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: �ctm'es Co r ru--)
Address of Property: tall � ►, T v,5
(Lot or Street #, Street or Road, City & County)
QC`
Agent's Name #: � �4 `��� C1tC�0 n Mailing Address: 6�1 � � n
Agent's phone #: r b S� (�c4Sx h vc V).QyOnl INC z � Ui -
I hereby certify that I own property adjacent to the above referenced property. The individual applying for
this permitdescribed to 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 the Dlvi . n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Cori � s should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represe� aan also be
contacted at [phone]. No response Is considered the some as no objection # been
notified by Certified Mail.
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.) .
azwl;'� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
G— Ct
Signature
Print or Type Name
Mailing Address
Gv-�rNI'N SC 2cl(pOS
City/State/Zip
�33(--IIA9-1(.015-
Telephone Number
L "% 5-`-'
Date
(Adjacent Property Owner Information)
Signature
a"H A 5, !'1 ez.se
r Print or Type Name
02.w/ sue'/`A
Mailing Address
Cit State ip
Jol &�'-u , o
Telephone Number
Date
Revised 611WO12

Bomestic Mail Only
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C3 ., 46
C3 Certified Mail Fee t3.35
ru $
Extra Services & Fees (check box, add fee j1prpptipte)
C3 ❑ Return Receipt (hardcopy) $ 7 Vim• I
O ❑ Return Receipt (electronic) $ $0 • 00
r3 ❑ Certified Mail Restricted Delivery $ i II I(j(1F1
I3 ❑ Adult Signature Required $ $0.00
❑ Adult Signature Restricted Delivery $
C3 Postage $0.49
$
_U Total Postage and Fig.
C3 $59
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0472 C3 Certified Mail Fee $3.35
04 � $
Extra Services & Fees (check box, add fee ITP Dare)
C3❑ Return Receipt 0ardcopy) $
Postmark ❑ Return Receipt (electronic) $
Here C3 []Certified Mall Restricted Delivery $ �-y �yr�
� ❑ Adult Signature Required $ ._�iF.t00
❑Adult Signature Restricted Delivery $
C3 Postage $0.49
04/25/2017
`a Total Postage and Fps 59
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■ Complete items 1, 2, and 3. A. Signature
■ Print your name and address on the reverse X
so that we can return the card to you.
■ Attach this card to the back of the mailpiece, B. Received
or on the front if space permits.
1. Article Addressed to:
�n\C'Q \ 1�
i���sytlle Inc Z$IIS
04
Postmark
Here
04/25/2017
Agent
❑ Addressee
C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address b0ow: ❑ No
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❑ dult Signature Restricted Delivery
OR -Certified Mail®
El Registered Mail Restricted
Delivery
❑ Certified Mail Restricted Delivery
eturn Receipt for
❑ Collect on Delivery
Merchandise
2. Article Number (Transfer from service label)
0 Collect on Delivery Restricted Delivery ❑ Signature Confirmation-
7 016 01.00 0000 8200
'-1 Insured Mail
r (over$5�) l Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
PS Form 3811, April 2015 PSN 7530-02-000-9053
Domestic Return Receipt
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■ Complete items 1, 2, and 3. A. Si 5pature
■ Print your name and address on the reverse ❑ Agent
so that we can return the card to you. ❑ Addressee
■ Attach this card to the back of the mailp %iece, B. Received by (Printed Name) C. D to of D % liv
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or on the front if space permits. j
1. Article Addressed to: D. Is delivery address different from item 11 ❑ Yes
Q'� If YES, enter delivery address below: No
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❑ Priority Mail Express®
❑ Adult Signature
El Registered MaiIT""
9590 9403 0603 5183 4333 46
❑ Adult Signature Restricted Delivery
rtified Mail®
❑ Registered Mail Restricted
Delivery
❑. Certified Mail Restricted Delivery
velum Receipt for
❑ Collect on Delivery
11 Merchandise
2. Article Number (IFansfer from service /abell
❑Collect on Delivery Restricted Delivery ❑ Signature ConfimnationTM
7 016 0600 0000 8200
I
4 815 I Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
PS Form 3811, April 2015 PSN 7530-02-000-9053
Domestic Return Receipt ;

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