66689D - Pedder

CAMA / DbREDGE & FILL
OQ
IENERAL PERMIT
A B
Previous permit#
,.Jew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources
Resources 15A NCAC
3astal Commission in an area of environmental concern pursuant
to
i
NameV� ra,'1 Q_�q�
❑ Rules attached.
Project Location: County
1;
z; k t
Street Address/ State Road/ Lot #(s)
A ooyn "VN it State _ ZIP1r1
ss
4 o H � o �' U iy1 J
E-Mail _
Subdivision
d Agent C� f1 CQ ��� J` �(� ��
Cityy�i(1_ t' ZI
❑ CW ,N�W )<PTA /KES PTS
15hone # (° �d) - 1'l l� River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
es / io P N A yes /(J
Project/ Activity r^ 0 V
<) length
iorm(s) - —
'latform(s)
gth f
fiber '
f Riprap length
distance offshore`
distance offshore
onel
c yards
P
e/ Boat/
X v ` G`
U-46 '
Length _qD
not sure yes
im: n/a yes
6) no
ttached: yes ('n�
Adj. vvtr. Body �, GtU (nat fm
Closest Maj. Wtr. Body
(Scale:
C ❑ See note on back regarding River Basin ru
g permit may be required by: j GWY 1 V 1 `->V I_X I
ocal Planning jurisdiction)

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: s; t)AOV\ PedI Permit #:
Date: v 9 /6 �-I�-O l
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Found in your Habitat code sheet.
iabitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/oi
temp impact
amount)
O yj
Dredge ❑ Fill Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
' 0 0 o
000
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

A4,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
at McCrory Braxton C. Davis
3overnor Director
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM
Date:
06/18/16
ime of Property Owner Applying for Permit
Simon Pedder
vner's Mailing Address:
1347 Shinnecock Lane
Indian Land, SC
29707
lone Number [phone]
M,"e,of Authorized Age t for this project:
CsZ COS-V�� % \
Agent's Mailing Address:
Ocs��s`e
Phone Number ��tt0) S 7 ci` c0Q
;ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
r and obtaining all CAMA Permits necessary to install or construct the following (activity):
Construction on a damaged bulkhead
)r my property located at 404 Dolphin St. Sunset beach, NC
its certification is valid thru (date)
12/12/2016
06/18/16
Property Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: pecldec'
Address of Property: AVA
(Lot of Street #, St
Agent's Name #: Gt` tZ. ejzn&,-L L��"A
Agent's phone #: %z- Eac\"yy5
or Road, City & Cou ty)
Mailing Address: L(y� ` �bW
(.J� nest, V; I �4L Z`6�M
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. Correspondence should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representatives can also be
contacted at [phone]. 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
1(Property Owner Information)
Signature
5 MGrJ 1�ed,dQ,r
Print or Type Name
13y-1, &h% VN
Mailing Address
\cyr1 t'} S L
City/StatelZip
Pr perty Owner Information)
,`o:s M�iY6404112yp rfr
Print or Type Name
�'0. $oXgzoo
Mailing Address
wyi/&,
City/State/Zip

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: _ 51 mdn P,46k r-
Address of Property: \---x'\r\ � ); �
t n inskQ - �C�Cou (OLQt
(� (Lot or reett #, Street or Road, City & Countyj
Agent's Name #:GV\IZX 'M,C,3`ls't> /�Mailing Address:
Agent's phone #: 1�d' S-iCA— ��� OMC-tr`
I hereby certify that I own property adjacent to the above referenced property. The individual applying for
this ljormil 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. Correspondence should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845, DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certisred 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
"4),q—Av,L�
(Property Owner Information)
Signature
ak UA) V � Q'1-
Print or Type Name
--
Mailing Address e
City/State2ip
(Adjacent Property Owner Information)
N
Print o yp me `
Mailing Adddrres'`
City/State2ip
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