72872D - Sheally

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+LAMA / ElDREDGE & FILL U r l� NO. 72872 A B C
• GENERAL PERMIT Previous permit #
lew -iModification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality/'qDG
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC //7'
ElRules attached.
Applicant Name ��'7 >/7 C L �� Project Location: County /f/1 /y 11 N ;;e
Address "� Street Address/ State Road/ Lot #(s) S/y ff" 'y
City W /L „- ti 199 n/ / State Ale ZIP_P%1
Phone # ( %� yD9"��6.� Mail �Sf/G=91 /Y10 Subdivision 13A1,YSf/a,PE
Authorized Agent CiZIP .��``/��
Affected El )4W �TA [IES El Phone # ( ) River Basin /441/ e a9ie
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body �irf G��S C,�EE, / (y d/man /unkn)
❑ PWS: /
h / %P.�H �✓� Lsa /✓
Agent Ap9 icant Printed Name Permit Officer's Printed Name
Sig a ** Please read compliance statement on back of permit
--2/q/) ---V'l�f
Application Fee(s) Check #
SignaturAr-
lssu(ng D e Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: WILLIAM SHEALLY
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
615 CHABLIS WAY
WILMINGTON NC 28411
910-409-5631
JSHEALLYC SENT.COM
L LA�T� Ay,,I/ kA`l�n,
Agent / Contr ctor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
1
at my property located at 814 BAYSHORE DRIVE, WILMINGTON NC 28411 ,
1 furthermore certify that 1 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 evaluating information related to this
permit application.
Property Owner Information:
Signat
WILLIAM SHEALLY
Print or Type Name
Title
Date
This certification is valid through o� / a3
MAC 0 8 201:9

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to WILLIAM & JANA SHEALLY S
Name of Property Owner)
property located at 814 BAYSHORE DRIVE, WILMI GTON, NC; 28411
Address'Lot, Block, Road, etc.)
on BRIDGERS CANAUPAGES REEKinWILMINGTON, NEW HANOVER
(Waterbody) N.C.
(City/Town and/or County)
Thapplicant has described to me, as shown below, the development proposed at the above location.
_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
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.)
I do wish to waive the 15' setback requirement.
_ 1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adj ent Property Owner Information)
Si ature Signature
WILLIAM SHEALLY Z42
Print or Type Name Print r Type Namp
615 CHABLIS WAY �R
Mailing Address i 'gAddres
WILMINGTON, NC 28411 Citylstatelzip !Telashone4
910-409-5631 Telephone Number N Mhlc
Date
r ( 11 (Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to WILLIAM & JANA SHEALLY S
Name of Pro erty Owner)
property located at 814 BAYSHORE DRIVE, WILMI GTON, NGA28411
Address, Lot, Block, Road, etc.}
on BRIDGERS CANAUPAGES REEKin WILMINGTON, NEW HANOVER , N.C.
(Waterbody) (City/Town and/or County)
The plicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(property Ow ormation)
Signature /
WILLIAM SHEALLY
Print or Type Name
615 CHABLIS WAY
Mailing Address
WILMINGTON, NC 28411
City/State2ip
910-409-5631
Telephone Number
Date
Owner Information)
.--U rvLuna&,,UT�P-,
Print or Type Name
61 q) -B�ee- —
MaW g Address
U
City/State2ip
9io ram'. 1903
Telephone Number
_ Z 2-3 tg
Date
(Revised 611812012)

Date Received
Date DepoWW
Check From Name
Name of PemJt Nokler
Vendor
Check Number
amount
Permit Number/Comments
Revel t w Refund/Reallocated
Columnf
Column!
Column3
Column!
Co/umn5
Column8
Cok 1
Column8
Co/umn9
31 019
Wtham I
rel
3
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