75880D - Kibler

krCAMA / DREDGE & FILL
ENERAL PERMIT
ew ---]Modification ] Complete Reissue ❑ Partial Reissue
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
Applicant Name VQ4- f is A /I116
Address <i a ✓�C
City State 6-'A ZIP �CU ¢
Phone # � �� ) — b 6 r 1 I L E- ail
Authorized Agent ✓ h
Affected ❑ CW F�iW �WTA ❑ ES ❑ PTS
AEC(s): ❑ OEA HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes /� PNA yes 'C_J
No. 75880
Previous permit #
Date previous permit issued
d 7 N - /Zv o
Rules a ched.
Project Location: County "
Street Address/ State mad/ Lo #(s)
Subdivision
City l t� �r ZIP
Phone # ( —'7'—" "" River Basin j�4, . 0
� Q 4
Adj. Wtr. Body C�-� `� N nat srrunkn
Closest Maj. Wtr. Body S' � U `- I_-
Type of Project/4
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Ag�jK or Applicant Printed Name
Signature Please read compliance statement on back of permit**
Application Fee(s) Check #
Permit icer's Printed Name
Sign e
'�/ V ,.
Issuing Date Expiration Date

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• complete iterl,s 1, 2, and 3.
a Print vour narne and address on the reverse
so that we c,:;it return the card to you.
a Attach this card to the back of the maifplece,
or on the frorit if_space pe►mits__-----
..t. /.triicle Adclrassed to: r
�lil�l�l� lli �l��lll���1�1�3� IIIIII ���ill�
9599 9402 4356 8190 6683 61
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,� i,yhnl'-
7018 1130 0000 8466
PS Form 3811, July 2015 PSN 7530-02-000-9053
■ Complete items 1, 2> and 3.
■ Print your name and address on the reverse
so that .ve can return the GOrd tO you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Articke ltddressed to:
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tf YES. eater delivery address
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❑ Addresse
C. Date of Delive,.
D. Is deli ry address different frcn itettt 1 ? ❑ yes
If YES, enter delivery addie s b6ov.: 0 NO
1 ffl CC I Service Type Priority Mai! Expies,
C Adult S gnature Restricted D�l;vera Red, stared h"�astered '1TRes
`�i Certified Maly Gvlwery
9590 9402 3j�a �i6.!, ? Certified Mali Restricted Delivery 0 Return Receipt for
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insure Mail Restricted Delivery Restricted Delivery
PS i=ot-m 3811, July 2015 PSN 7530-u?-000-9050 Domestic Return R+

A176L11 1 P%V 1 t IWIXIA—M a 0%01 � Y Oak ♦ as�Iwv" .,••• s•.. _ ___..
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
CU S tM ion e . C D ctiC
I certify that I have authorized
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my my property located at D VeGym t✓ ,
in _ t'��i� County.
I furthermore certify that l 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 evaluatng information related to fhis
permit application.
Property Omer Information:
Signature
Print or Type Na
itle
l_ 1_6 r a02.&
Date
This certification is valid Through

M
Fax"
CONFIDENTIAL HEALTH..INFORMATION ENCLOSED
i WILLIAM D. WHITSETT, DDS
Healthicare information is personal and sensitive information related to a
persons health care. It is being faxed to you after, appropriate
authorization from the patient or under circumstan es that does not
require pa
tient authorization, You, the recipient, art obligated to maintain
it in a Safe. secure and confidential manner. Re -disclosure wlt ou
additional patient consent or as permitled by law is prohibited.
Uneuthonzed re -disclosure
failure
d in fedeaal and statedtawl,aliry could
subjecd you to penalties describe
From: ;y
o: Ioate:
Fax: id•37�•-�1 I 2 ,-,/I �/ /I
Phone ages: r3 IlVt^i/UL��I�I
Re: c:
i O Please RocyClo
O Urgent O For Revlew O Please Comment O Please Reply
coma! eras:
I
i
IMPO �TANT WARNING. This message is intended for the use of the
person or entity to which it is address is contain information
tn thatby
is privileged and confidential, the disc,losu a of which govern
applicable law. If jh@ eeader,of this message is not the intended recipient.
you ar hereby notified.-I,h zany dissemination, distribution or copying of
the information is STRICTLY PROHIBITED. If y° de11 stroyehe related
messa$le by error. -please notify us immediately and
message.
i
RECEIVED
MAR 17 2020
DCM W►LMINGTON, NC
1
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Recelv"p
MAR 17 2020
ACM w/LMINGT pN
NC

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RECEIVE p
MAR 17 ?020
DCIN wILMINGT pN
NC

B C
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RAL PIRRM I
rrevlout permlt#
&i m ffleition- npip ci)m, Reissue
ssue 12Pardal R I elssud Date prev. 10! . #pe . rmli
As author) ed by tiv*.$We of Nwfi Carolina, Departm4m*Eq*6*q�fAl gyplity-
WIN* Coastal ReOWr* 06himissl6n lt� an area of environmental conc . m' pursuant to I 5'A NCAC
Applh :Aht N�rilie Pi-olect Location: County_-. 7T
Address $
Weg;-Md . — . . .
4�V
to 67-A-2JPJOq
P11006 *
I L7
Subdivolon
Authori7ed Agent ZIP zY�
Affected ucw V TA LIES OPTS Phone # River Basin
D 0 E A HHF E) 04 1-1 U13A rj jQA 4
Ak(s): r kt
I Wv� 800y____,/ , a Ad!:
F] Pws:
7.m.
ORWc
Closest Mal, Wtr. Body
Yes. PNA
'y s po:
'OfTrOject! AWY14
Plot (dock).
0;
FiXe.0 Platt"
FINO'. p
Oulkhoad/ fkiprsp t
ays di.kame
max distmce
BAsIn. channel
001C
Boat rati�p
Reach WWI
Other__
Shoreline Length
not -ia� y0i
moratorium
ivi Yes
Photos -yes no 1 r
Waiver Attached-,
yes
A-bvildi
ng pernilc nlay be requti cd
(Note Local PJanMn9)urIsdkt6).
Notes! Special Conditions
,
'Please sad co*hancestatemefitortback f'-iwm'it**
is? cC`etk #
(Scale;
EI See note on back ,rcgaHff River.0.isirt ruts:
9*0kilt1oh Datit

Check
Date R-WVed
Daro
Check From ame
Neme of Finnit Molder
Vendor
ChOO Nwnber
amount
Parton Number/Commenb
RdOW or Rerund/Reallonted
Co1umn1
COlomn2
_ Column3 _
COA�MM
Columns
ca"101((
column?
CulnmM
COYmm9
4/2112020
PFI Construction LLC Mary, Denise, Michael Thomas Jol
Navy Federal CU
7032 $ 600.00 GPt76103D
JD rct. 10336
4/21/2020
Lighthouse Marine Constrction Doc and Gin 10bief
Coastal Bank
3145 a zoo.00, GP/75880D
JD rat. 10335
arine Contractors LLC Charles ton
First Citizens Bank
_
_--
GP #75881 D
JD rct
4/21P2020
Holden^Docks and Bulkheads Frank Atkmdson
CresCom Bank
3829
$ 200.00 GP #75804D
Bbnnk rct. et. 10669
10
2112020
Grice Constructionr—
xof Brunswock Myra Dove
BB&T
13765
$ 200.00 GP #76118D
Bbrink rct. 10423
Robert Moore
County1/2020 Grice Construction of Brunswick --
BBBT
�— 13767
$ 400.00 GP #75856D
Bbnnk rct. 10424 --
4/21/2020
by Jordan
Construction of Brunswick County In'ie
Sh�Ne--M'
B88T
13766
$ 400,00 GP#75857D
Bbrink rct. 10425
4/21l2020
Clements
Clements Marine Construction McGirt
B88T
_
_
$ 400.00 GP 076126D
PA rct. 10356
/21/2020
New and Ily Baxter Baxter
— —
-
Fargo
_5407
7940
$ 600.00 GP $76408D
Bbrink rct. 10422
4/21 /2020
Watson CE
�
7942
600. GP i75879D
1C, rct. 10831