74680D - Medlin

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-. NCAMA / DREDGE & FILL NO. 74680 A B C Q
• GENERAL PERMIT Previous permit #
INew —Modification []Complete Reissue []Partial Reissue Date previous permit issued
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
❑ Rules attached.
Applicant Name Dor� t�QA\\Y\
Address ZCq L toes Lna
City A State �C, ZIP;Li31JH-6
Phone #( ) N hA E-Mail N A
Project Location: County
Street Address/ State Road/ Lot #(s) 9-01A
on S I ,n,e-
Subdivision N
Authorized Agent Lra� N1pnnge^eAA (ruup (�1� CityArs. }essa ZIP 'R�Lf-5
Affected ❑ CW DEW El PTA PSES i,PTS APhone # (JO ) �15�. Von 1 River Basin wti��t Cook..
AEC(s):
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /(�p PNA yes no
Adj. Wtr. Body Cl*-(\o k (nat m�/unkn)
Closest Maj. Wtr. Body MW W
Agent or Applicant Printed Name Permit Officer's Printed Name
r.�,[ c.l�� t i r� � /'; �.%ill (� ✓ �J �-----
Signature Please read compliance statement on back of permit Signatur
tyo() *"- 4 +409
Application Fee(s) Check # Issu' g Date"Ex iratic n Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Dorothy Medlin
Mailing Address: 209 Lea's Lane
Hampstead, NC 28443
Phone Number:
Email Address:
I certify that I have authorized Land Management Group
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Placement of Headwall
at my property located at 209 Lea's Lane
in Pender County.
i furthermore certify that i 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:
Sigm ture
-De)re%k � ec��;�
Print or pe Name
Property Owner
Title
4 20 i 2019
Date
RECEIVED
This certification is valid through 12 /31 12019 APR 2 3 2019
DCM WILMINGTON, NC

LMG
LAND MANAGEMENT GROUP
a DAYEA company
April 23, 2019
Jason Dail
North Carolina Department of Environmental Quality
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405
Jason,
On behalf of Dorothy Medlin I would like to request a CAMA General Permit to place 164 ft of bulkhead
at 209 Lea's Lane, Hampstead, Pender County, North Carolina as depicted in the attached site plan.
Please find enclosed a Site Plan, Agent Authorization, $400 fee check, and signed Adjacent Riparian Owner
Notification / Waiver Form.
Please let me know if you have questions or need anything in addition to process this CAMA General
Permit.
Sincerely,
Andy Dortch
Land Management Group
Enclosures: As stated
Cc: Dorothy Medlin
RECEIVED
APR 2 3 2019
DCM WILMINGTON, NC
www.lmgroup.net • Phone: [phone] • Fax: [phone]
3805 Wrightsville Ave., Suite 15, Wilmington, NC 28403

4LMG
LAND MANAGEMENT GROUP
a DAVEY# company
April 18, 2019
Bert L Lea Jr. et al
301 Lea's Lane
Hampstead, NC 28443
To Whom It May Concern:
Dorothy Medlin is applying for a CAMA General Permit on their property located at 209 Lea's Lane,
Hampstead, Pender County, North Carolina. The specifics of the proposed work are depicted on the
enclosed Site Location and Plan View drawings.
As the adjacent riparian property owner to the aforementioned project, I am required to notify you of the
development in order to give you the opportunity to comment on the project. Please review the attached
permit drawing. Should you have any objections to this proposal, please send your written comments
within 10 days of your receipt of this notice to:
Jason Dail
North Carolina Department of Environmental Quality
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405
Comments will be considered by the NC Department of Coastal Management in reaching a final decision
on the application. No comment within 10 days of your receipt of this notice will be considered as no
objection. If you have any questions on this project, please call me at 910-452-0001, or e-mail me at
[e-mail]
Sincerely,
i
Andy Dortch, Agent
Land Management Group
Enclosures
RECEIVED
www.lmgroup.net • Phone: [phone] • Fax: [phone]
3805 Wrightsville Ave., Suite 15, Wilmington, NC 28403 DCM WILMINGTON, NC

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual applying for Permit: Dorothy Medlin
Address of Property:
209 Lea's Lane, Hampstead, Pender County
(Lot or Street #, Street or Road, City & County)
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 or drawing, with dimensions, should be provided with this letter.
x I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Avenue, Morehead City, NC, 28557 or call [phone] within
10 days of receipt of this notice. 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, boatlift or sandbags
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.)
NA I do wish to waive the 15' setback requirement.
NA I do not wish to waive the 15' setback requirement.
(Applicant Information) (Dorothy Medlin)
209 Lea's Lane
Mailing Address
Hampstead NC 28443
City/State/Zip
Telephone Number
4/20/2019
Date
(Riparian Property Ow er Information)
Sign ture
Bert L. Lea et al
Print or Type Name
Telephone Number
4/20/2019
Date
RECEIVED
0 ` 9 3 — ,j
DCM WILMINGTON. Nr,

Date Recehred
Daro Deposited Check From Neme Name of Permit Holder
Vendor
Check Number
Check
amount
Permit NumbenComments
Receipt or Relund/Reallo<ated
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