69196D - Cochrane

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
j�Jew Modification ❑Complete Reissue []Partial Reissue
r
As authorized by the State of North Carolina, Department of Environment and Natural
and the Coastal Resources Commission in an area of environmental concern pursuant t
Applicant Name Q & ) ( 0 ( h Y-A
Address_ } �Ij b b m 5(at Ciry iy�'� [� w'�, State ZIP 2 50 S
Phone # (TO'J �S -i4 E-Mail
Authorized Agent J O �-"y^ S �—
Affected El CW XEW PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ElHHF ElIH ElUBA ❑ N/A
ElPWS:
­o�
Agent or Agplicapt Printed Name
Previous permit #
Date previous permit issued
o
Resources
I SA NCAC
Rules attached.
Project Location: County OrJL4�-'
Street Address/ State Road/ Lot #(s)
1- 7 (v wA1, �✓ 1 A 0 d
Subdivision
city C w►, 51t l act^ zip
Phone # River Basin L V M
Adj. Wtr. Body of0, 'A nat unkn
('Inner Mei WfRrl r ny I1 W / LA
Permit Officer's Printed Name /I
Signatu *` * Please read compliance statement on back of permit **
1bb.0D !1(a
Application Fee(s) Check #
Signature v
1-7
Issuing Day VpiratiDate

Date
Received
Date
Deposited
Check From
(Name)
Name of Permit
Holder
Vendor
Check
Number
Check
amount
Permit Number/
Comments
Receipt #
5/17/2017
Walter Mark Stacy
Paul Cochrane
BB&T
1496
$200.00
GP 69196D
SF rct. 4244D

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: V J C 0 G "V-C, l
Date: 6 6 /(-1 /�'-0
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
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount)
'
W
Dredge ❑ Fill ❑ Both ❑ Other
156
l J 6
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 11 `` f ,? ` Cam-' / -7
Name of Property Owner Applying for Permit:
/ 7
Mailing Address:
17�ilii J�ff�T�A0
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) /J" vj DOCK
at (my property located at) `{` j OVmM eR-1 4) 5t U[ea,J .15le '13. PIS k /V C- ZW-f eo l
This certification is valid thru (date)
�/ iz zory
Owner Signature Date

Docu8ign Envelope I0:FCD2219A-B414-4E59-BA7E-744E471423F6
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAG91MENT
ADJACENT RIPARL-N PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: `� ��Un�l la ��� �>/ sl ace" 1 S le &el- d &4 S iv, i
(Lot or Street 9, Street or Road, City & County)
Applicant's phone #:_ r7d q- qqr - 7 3 7 g Mailing Address: 160 rtisU
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. A description of drawing,
with dimensions, mast be provided with this letter.
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 Division of Coastal Management (DCM
in writing within 10 bays of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the.same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that apier, dock, mooring pilings, breakwater, boathouse, :or lift 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
app aete blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Inforuratipn)
Signature
TAQL (avit
Print or Type Name n
rU
16 1
Mai ing ddress
1/0
City / State / Zip
Telephone Number
Date Ail ZD ,')
(Riparian Property Owner Information)
ZIanee by:
- NStut,r
Signature 5959352CIU"AC..
e ►Nl ( (ey
Print or Type Name
l 72 I ,z#,cMcw �\ ZJ
Mailing Addre
L lea ✓,o�t; . �V L Z�`Zz
City / State / Zip
Telephone Number
Date 4/14/2017
127 Cardinal Drive EA, Wilmington, Norlh Carolina 28405-3845
Phone: [phone] FAX: [phone] Internet: www,nccoastalmanagemen(.net
An Equal Opportunity l Affirmative Action Employer— 50% Recycled 110°16 Post Consumer Paper

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Certified Mail Fee c 114 % I f
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C3 Extra Services & Fees (check box. add fee'%1 rib te)
Return Receipt (hardcopy) $ 1 �-! "
17-1 ❑Return Receipt (electronic) $I I t i I I Postmark
I3 ❑ Certified Mail Restricted Delivery $ _. )� ii i Here
C3 ❑ Adult Signature Required $ ---- Kt-f{}+—
� M Adult Signature Restricted Delvery $
p Postage $ I.49
N $
))41 41?):(i
Er Total Postage and Fees
ri $3.34
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POSTAL. EXPERIENCE
Go to:
Itttps://pustalexperierle,e.com/Pos
840-5280-0570-002-00015-35865-01
or ,can this code with
yol_Ir mobile device:
or call 1-800-410-7420.
YOUR OPINION COUNTS
Bill #: 840-52800570-2-1535865-1
Clerk: 10

US MAIL
CERTIFIED MAIL — RETURi'N RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIP_ RIAN PROPERTY OWNER STATEMENT
Name of Property Owner: T��,-� t- 0 (� �x V CA �
Address of Property: �-� �(u vv\ t'y I L, vt ti D�-r t � t` eCcvt
--} (Lot or Street#, Street or Road, City & County) ) L?d
Applicant's phone : (C- - (i ! Mailing Address: % 1�C'rj (,' i=� �� �� t "' �I�t ���
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. A description of drawing,
with dimensions, must be provided with this letter.
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 Division of Coastal Management (DCM)
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the.same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that .a pier, dock, mooring pilings, breakwater, boathouse,. or lift must beset 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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signature
I
�t ✓1 v� r�
Print or Type Name
v.
Mailing Address J
i
_ L
City / State / Zip '
IXTelephone Number JIC
1
Date LA I�
(Riparian Property Owner Information)
Signature
Print or Type Name
1q Or&L)
Mailing Address t
silt i AC I i,1 . �v L : � � �C C-)�
City / State / Zip
Telephone Number
Date
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmalive Action Employer — 50% Recycled 110% Post Consumer Paper

7 57-