74324D - Bond

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VCAMA / _' DREDGE & FILL No. 74324 A B C
GENERAL PERMIT Previous permit #
'.New ❑Modification ❑Complete Reissue El 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 I SA NCAC
100
❑ Rules attached.
Applicant Name 7rjlyo-'Hy 1�UN� Project Location: County -�>6NpECZ
Address—; 00 C- "41)W AL 1 C f , Street Address/ State Road/ Lot #(s) 2 00
City AAtAJKTeA State PC ZIP 2P,44S -�-.00Tk C7ADWC—LL
Phone # (ft) �L1 5105 E-Mail SKy800�,0 yt�E?a� �0M Subdivision NJ14
Authorized Agent V-�IGAIIMY City NA MPS TOAD ZIP 2�'1�13
Affected ❑ Cw 2kEW 6J PTA ❑ ES ❑ PTS A(,E ft Phone # (q[D ) 3 51 V 3 1 _+ River Basin W N t TE OAK..
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body V t2tn "1 A4- (VE6 C K..r (4W/man /unkn)
❑ PWS:
ORW: yes / � PNA ® / no Closest Maj. Wtr. Body ��W
(Scale:
Pier (dock) length
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Agent or *plic)tnt Printed I ! n
Signature ** Please read compliance statement on back
4Zoo
Application Fee(s)
%-e i&& /V Ls��
e it Officer's Printed Name
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permit * Signature
Check # Issu ng Date Exp ration Date

Name of Property Owner Requesting Permit: Timothy Bond
Mailing Address: 200 South Gadwell
Hampstead, NC 28443
Phone Number: (910) 8 21- 510 S
Email Address: [e-mail]
I certify that I have authorized Richard Penny
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Install new Pier &
Platform.
at my property located at 200 South Gadwell, Hampstead, NC 28443
Pender
in County.
i 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:
1
_ Signature
t Nl.�r-4•; �� N
Print or Type Name
Title
/ ©S /
Date
This certification is valid through 09 1 22 1 2019

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Timothy Bond
Address of Property: 200 Gadwell CT, Hampstead, NC 28443
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Richard L. Penny Mailing Address: 133 Sound View Dr, Hampstead, NC
Agent's phone #: [phone]
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, 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. Contact information for DCM offices is available
at http://www.nccoastalmanapement.netlweb/cm/staff-listincl or by calling 1-888-4RCOAST. 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, boat ramp, 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 appropriate blank below.)
I do wish to waive the 15' setback requirement.
�W �A I do not wish to waive the 15' setback requirement.
(Property Owner Information) rJR parian Prop y ner nformation)
6 i4 -- 16
Signature Signature
1,'.0,,2ClN 0,2gfi1Q Richard L. Penny for Timothy Bond
Print or Type Name
4w WE L L
Mailing Address
City/State2ip
a1 ku -2t,z-'S 3��- / Ab u rz�31�� ntzk4oKkom-
eo vt�
Telephone Number/Email Address
-3t�1ft
Date
Print or Type Name
200 Gadwell Ct
Mailing Address
Hampstead NC 28443
City/State2ip
[phone] / rick(d--)rpcmarine.com
Telephon Number/Email Address
z
Date
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Timothy Bond s
(Name of Property Owner)
property located at 200 Gadwell Ct
(Address, Lot, Block, Road, etc.)
on Intracoastal Waterway in Hampstead 28443 / Pender County, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
"'t 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, boat ramp, 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 Owner Information) (Adjacent Property Owner Information)
Si nature Signature
Richard L. Penny (for Ghada-Hick�j`
Print or Type Name Print or Type Name
133 Sound View Drive
Mailing Address ` Mailing Address
/ii Z-Y lY> Hampstead. NC 28443
City/State/Zip City/State/Zip
Telephone Number / email address
Date
'Valid for one calendar year after signature'
[phone] / rick(Wrpcmarine.com
Telephone Number / email address
Date *
(Revised Aug. 2014)

Date Received
Date Deposited Check From (Name
Name of Permlt Holder
_ Vendor
Check Number
Check
amount
Permit Number/Comments
Race) t or Refund/Reallocated
Columnl
Colum12 Co1umn3
Columnl
_ Columns
Cdumn6
Column?
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Column9
6/14120
Rkhar Penn Con h 0 n
I T-.o Bond
Naw F deral CU8727