67190D - Pope

'rAMA / ❑ DREDGE & FILL 13 f) V A B
;E L PERMIT L Previous permit #
�jew odification ❑Complete Reissue ❑Partial Reissue '^�1 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 I SA NCAC
❑ Rules attached.
t Name J I laUI� f V� - - ' Project Location: County k 4le i
44 r �F r' n t4(r or f a / a-,� Street Address/ State Road/ Lot #(s)
trtZ1`Tt State'I•'-"—' ZIP a.•�
E-Mail
ed Agent
❑ cW ] EW Q PTA ElES ❑ PTS
[IOEA 10 HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
yes / no PNA yes / no
f Project/ Activity
,ck) length t
atform(s) tie X� p
;ngth
amber
id/ Riprap length
g distance offshore
ax distance offshore
hannel
ibic yards
mp j7 X.
r
use/ Boatlift t� ti
3ulldozing
ne Length
not sure yes no
>rium: n/a yes
yes
o
Attached: / des) no
Ping permit may be required by:
Local Planning jurisdiction)
Subdivision
City =' ` ^C e ZIPS
Phone # O �� River Basin
Adj. Wtr. Body/a-7- ��< ( =_'° t nat i
Closest Maj. Wtr. Body L: if
(Scale: V =1
❑ See note on back regarding River Basin

NC Division Atf
Applicant
Date: t 1 1
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 FIN
(Applied for. (Anticipated final (Applied for. (An,
DISTURB TYPEDisturbance total disturbance. Disturbance 0
includes any Excludes any total includes. Exc
Habitat Name Choose One anticipated restoration any anticipated resi
atioand/or temp restoration or tam
restorn or
tem impactsImpact amount tem irti acts aml
Dredge ❑ Fill ❑ Both [I Other (�
Dredge El Fill Fill Both. ❑ Other ❑
Dredge [] Fill C] : Both _❑ Other El
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑. Both ❑ Other ❑
Dredge ❑. Fill ❑ : Both ❑ Other ❑
y Dredge ❑ Fill ❑ Both ❑- Other []

ayment Proccessing Confirmation
late Received 11/22/2016
heck From (Name) Charles F. Riggs & Associates Inc.
lame of Permit Holder William & Mary Pope
rendor First Citizens Bank
:heck Number 14814
:heck amount $400.00
lultiple Permits No
lajor/Minor
ermit Number/Comments GP 67190D
',eceipt or Refund/Reallocated JD/2496D

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
August 16, 2016
Date
Name of Property (honer Applying for Permit:
Tracy Pope and wife, Beth Pope
Mailing Address:
494 Parker Memorial Road
Clinton, NC 28328
I certify that I have authorized (agent) Charles F. Riggs & Assoc. to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) proposed dock, as shown on map
at (my property located at) 4073 4th Street, Surf City, Onslow County
This certification is valid thru (date)
August 16, 2017
August 16, 2016
Property
Signature
Date

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Tracy Pope and wife, Beth Pope
Address of Property:
4073 4th Street, Surf City, Onslow County
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Charles F. Riggs & Assoc.
Agent's phone #: [phone]
Mailing Address: P. O. Box 1570
Jacksonville, NC 28541
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.
L--- 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 www:nccoastalmanaaement.net/contact dcm htm 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, 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.)
do wish to waive the 15' setback requirement.
_ I do not wish to waive the 15' setback requirement.
(Prope,gy Owner I
Signature
Charles F. lei
Print or Type Name
P. O. Box 1570
ation)
gent for application
Mailing Address
1nt-1fcnnvi11^ nth 70LA4
(Adiar t P4ciperty Owner Inf
Si;�/V/
ure
C-
Print or Type Name
Mailing Address
„/ 0 .
nation)
L
Mal

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Tracy Pope and wife, Beth Pope
Address of Property: 4073 4th Street, Surf City, Onslow County
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Charles F. Riggs & Assoc
Agent's phone #: [phone]
Mailing Address: P. O. Box 1570
Jacksonville, NC 28541
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 drawin 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 www nccoastalmanagement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
b ect►on ►f you have been notified
response is considered the same as no ob Certified Mail.
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.)
V(,ll do wish to waive the 15' setback requirement.
PIA se ac re nt.
(Prope,4y Owner I
Signature
Charles F.
Print or Type Name
P. O. Box 1570
ation)
nt for application
(Adja t Rroperty Owner Inf mation)
4
Si ga7 a •e
C� c L f ►��l
Print or Type Name
r-J er� A)-
Mailing Addresq

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Tracy Pope and wife, Beth Pope
4073 4th Street, Surf City, Onslow County
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Charles F. Riggs & Assoc
Agent's phone #: [phone]
Mailing Address: P. O. Box 1570
Jacksonville, NC 28541
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 ar proposing. A description or drawing with dimensions must be provided with this letter.
l� 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 www nccoastalmanapement.net/contact dcm.htm 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, 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 wave 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.
(Poope y Owner Ir"mation)
Signulure
Charles F. ig gent for application
Print or Type Name
P. O. Box 1570
(Adjacent Property Own e nformation)
. 'i <, ul ta•e
1 '45
10
Print or Type Na e
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