73514D - Bardhill

' CAMA / DREDGE & FILL
GENERAL PERMIT
'XNew El Modification ❑Complete Reissue ❑Partial Reissue
No. 73514
A B C O
Previous permit IF
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 07H. 1 2-O 0
❑ Rules attached.
Applicant Name CAMU-ES & WAWA4 SARDILL,
Address 3712 Picgrg, ST
City SA.dF,-,p_p State ZIP .27 33o
Phone # [phone] E-Mail
Authorized Agent ( A-M 94N
❑CW
XEW
APTA ❑ES ❑PTS
Affected
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑USA ❑ N/A
❑ PWS:
ORW: yes /(o)
PNA
yes / no
�0.• Project Location: County pRutNSwlcK Street Address/ State Road/ Lot #(s) 18' 10
9
EAsr 57rA Aira.r_ CA4A` S W
Subdivision SrA Ater- CANAL_
City ""s wPR.y ZIP 2 r *&Z
Aorwr Phone # (9 10)tSo-4381 River Basin Lan Arr_r_
Adj. Wtr. Body CANAL. (nat a9 /unkn)
Closest Maj. Wtr. Body A I W W
1
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Agent or Applicant Printed Name
Signature *• Please read compliance statement on back of permit
' c� 4k2Z6 5
Application Fee(s) Check #
�,c,elz MC cim,Rls.
Permit Officer's Print ame
r r
Signature
,+/I 19 $1I A9
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C h a r f( s f G% hrt _-,(a r al c/, l
Mailing Address: 03'1 i2 VJI Gk e2 .5T
5ANFoje-D NC- 21330
Phone Number: q IG - 77C - y-l-tC Lm _ac9 - `7-10 - C1(aZ>
Email Address: W ba `o{: t ( /,D q-4an; ( c�-o m
I certify that I have authorized H5 Construction
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
.Tq.�__i cy V)11c7
(. e
OWI
3 x a
a.
at my property located at
i S
9 9
in
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:
Signature
WAPPA i3A2Dt / CAAV.Lj_05 (LL -12—
Print or Type Name
owble2
Title
3 l zr 1 to
Date
This certification is valid through / 1

ADJACENT RIPARIAN EROPERTY OWR STATEh:ENT
t hereby certify that t own property'adjacent to C.' ha vjc$ fi W a t uk a 4as-d d l 's
Property located at qv ve. WOR
an C_' C h Lt (AdMik Lot, Block, Road, etc.)
-- �' Y b ,L N.C.
(Waterbody) (' yITOM andtor Coumy)
The
applicant has described to me, as shown below, the development proposed at the above location.
l have no objection to this proposal. Y
l hove objections to this proposal.
DESCRIPTtQN A! NDIOR pR7VVING OF pRoPOSED DEVELOPMENT
(Ind/vldus/ proposMg develapment must fill In descdpdon below or attach a site drawing)
i�" �Join-- 1 &4 G+—J 3 x S P W-f�,,n,
WAIVER SEC7tOH
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be get back a
minimum distance of 16! from my area of riparian access unless waived by me. (if you wish to waive
the #back, you must in�l the appropriate blank below.)
C ` t do wish to waive the 15' setback requirement, v
1 do not wish to waive the 15' setback requirement.
(ProAerhl Owner information) (A card Property Owner information)
Signature S! nature
A �aR.DILI. 'rRlC iA jCLeMrKO u s
Print or Type Name Grint or Type Name
�sit2 rCK� Sf toe'lls s� .(� C kt1
Malting Addmss MaNing�
�AlJ 7 NG 2 7sS
30 .�B,Y N c
CitylState/Zfp City/w lek
Telephone Number Tatephone lVrtrrtber
Date Date
(Revised 611 ttr2012)

AD+IACENT RIPMIAN_PROPg= Q ATE
I hereby certify that I own WWW'sdjacent to ChclYl's t WOrWa &rd s i I 6
property located at (Z Qq E 4ire ra ' !r"Wty 0WnQ4
(Address, Lot, R
C` Bock lo&d, etc.)
on n " (Waterbody) t r Ro/U and/or o6 , N.C.
( County)
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.!,
I have oblections to this proposal.
DESCRtPT" A ID[JC i DRA"NQ OF PROP032D DEVELOPMENT
(lndiv/dusl proposing development must till in description below or attach a site drawing)
7V1.S h"-U I90c*— (I cra ck 3
WOOR SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, Oft, or groin must be set back a
minimum distance of 'I & from my area of riparian access unless waived by me. (If you wish to waive
the setback, you must in#tlal the appropriate blank below.)
1 do wish to waive the 15' setback requirement, x
I do not wish to waive the 15' setback requirement.
(Propsrty Ownet lnfamution) (Adj card Property Owner #nformst#on)
Signature Signature
Pant or Type Name Rrint or ate Name
712 W ST go 3 W Sew1 i2e C�aA c.
Mailing Addmss McNing Address
--sue NG z�33a St,�PP�Y IVG T S�4-� 2
c ty/srere2lp cily/sratwZip
aIg--7 704-776 gIo-EILtZ-(a591
Telephone Number Telephon6 Nuer
Date Date
(Revised 6/1WO12)

PROJECT: 1899 E. Sea Aire Canal
HS CONSTRUCTION, LLC

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