66355D - Frazier

CAMA / ❑ DREDGE & FILL ;L A B
3ENERAL PERMIT l V r Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
'oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC } rl • (�e %�'
❑ Rules attached.
:Name �r%l� - �(�Z-� Project Location: County �VyAsk
`'S �f Street Address/ State Road/ Lot #(s)
State�z'1p`/�
S , D`S E-Mail j� Subdivision
:d Agent ��� �,- �.r�1�� City U�1s�-�` �d LU�`:�V \ ZIP
❑ CW )kW X*TA ❑ ES ❑ PTs Phone (� )�� O^ j �f' River Basin L
❑ OEA ❑ HHF ❑ IH ❑ USA EJ N/A Adj. Wtr. Body An V 1A V 66 /n
❑ PWS:
res / no PNA yes �'V no Closest Maj. Wtr. Body V V
Project/ Activity
1x
k) length
'-f-tel `i . X
igth
fiber
/ Ripb p length
dist>tnce offshore
c di , ce offshore
in el
i yards
e/ Boatlift
Ildozing
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&M910MOOLIONAMOMEN Mill
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❑ See note on back regarding River Basin

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant: / au,\A Fr-7\z- il/
Date: * p 5A046(
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex,
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
temp impacts)
impact amount)
ternimpacts
arc
. /
®V V
Dredge ❑ Fill ❑ Both ❑ Other
0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

b 22 16 05:19p Cam & Chris Frazier 910-579-6418 p.1
5F-Gi
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: L-23 W.S.-A .31 AC Twin Lakes Dev. PL 17/47
LOT NO. --PLAN PTO. --PARCEL I.D. 256Fi OF_9 ...,....,.___-__
STREET ADDRESS:— 309 Shoreline Drive West. Sunset Beach North Caclina
Property Owner (please print): Mr. & Mrs. David C. Frazier --
The undersigned, registered property owner of the above noted property, does hereby authorize
Southern Environmental_Group, Inc. (SEGI)_to act on my behalf in matters regarding areas of
environmental concern.
Property Owner's Address (if different than property above):
Telephone:
l'/v r75OLS(o
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge. ,
Property Owner Aut ized Signature SEGi Authorized Signature
Print Name
Date
Dana A. Lutheran .
Print Name
_ ?2 Fehraary 2Qiti
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Cam Frazier s
(Name of Property Owner)
property located at 3 0 9 Shore i- D r- - w,-s t
(Address, Lot, Block, Road, etc.)
on ATC*h ! In F.7,-i nr qungpi- Tlpach , N.C.
(Waterbody) (City/Town and/or 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 objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must Fill in description below or attach a site drawing)
Dock plan sent seperately
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.
kr-r- I do not wish to waive the 15' setback requirement.
(Property Owner Information) (4dj�centP„r¢per$ O,wr�ef (nfior iop),'
Signature
uana Lutheran for Cam Frazier
Print or Type Name
5315 S. College Road Suit^ E
a�
Mailing Address
M.liing Addres / / n /,'r

■ Complete items 1, 2, and 3. Also complete A. Si nature
j itlam,44"11s5fcted Delivery Is desired. X ❑AgarA
■'Paint bur name and address on the reverse, c p q�r
Stj th$$t we Ga((�� r�eturn lkte card to you. B
. alved by (Printed Name) �2. Date of De
• 'PittacN'thi� E aFd to the back of the mailpiece,
tiron the front if space permits. C-
- c
1. Arilcle'Addressed to: eliveryaddress different from Item ❑ Yes
If YES, enter delivery address below: ❑ No
LOB
j vim,
,l1�,4� tip?`
3. Service Type
❑ cwffw Mail ❑ E59ress Mail
11111111111E 11111111111111111111111111111111 ❑ Insured I ❑ aOReturn Re�Ipt for Merch�
4. Restricted Dellvery? (Extra Fee) ❑ Yes
2. Article Number
(Aansfer from service fabeq 7009 3 410 0001 3383 1650
PS Form 3811 Febru_ery_20Q4 Domestic Return Receipt f ogy

309 Shoreline Drive West, Sunset Beach, NC
Proposed Dock
Prepared by SEGi on 3 March 2016 (Revised 4 May 2016)