66386D - Stratford

CAMA / ❑ DREDGE & FILL q B
'ENEF AL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El 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 t, 0 0
x ❑ Rules attached.
Name / Project Location: County L M\S1MZ)
I1� U\ y ,y,�y Imo. 5u Street Address/ State Road/ Lot #(S)
State zip V� V
(U �� Subdivision `� f` �' "�
ed Agent �Y� �% �1 j �n tom-. City�l L1r1ll {-�1 t' ,Jc �l �1 ZIP`C�i'�
❑ CW ❑ EW ❑ PTA ESPTS Phone # (v I ") — 61d River Basin
❑ OEA ❑ HHF ❑ IH �� ❑ USA ❑ N/A Adj. Wtr. Body "\Jj at r
❑ PWS:
L� Closest Maj. Wtr. Body
yes / no PNA C` J / no

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant:
Date:
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
FIh
(Applied for.
(Anticipated final
(Applied for.
(An
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dist
Habitat Name
Choose One
includes any
Excludes any
total includes
Exc
anticipated
restoration
any anticipated
rest
restoration or
and/or temp
restoration or
terr
temp impacts)
impact amount)
temp impacts)
am
Dredge ❑ Fill ABoth ❑ Other ❑
r) 5 V O
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _SLF III — NC Brick Landing, LLC
Mailing Address: 5949 Sherry Lane, Suite 1750
Dallas, TX 75225
Phone Number: 214.239.2373
Email Address: ovest(a)-stratfordIand. corn
I certify that I have authorized Brunswick Dredge and Dock
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: bulk head repair
at my property located at Goose Creek Road SW Ocean Isle Beach, NC 28469
in Brunswick 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:
~Signature
Print or Type Name
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to `%�i�2GPi, "/�CaJ C
(Name of Property Owner)
property located at % �`6 2 F�a-k�v-Lr\, Sw .
(Address, Lot, Block, Road, etc.)
on ;� : , in Qcela-n Es ►c GfAC- .
N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above lo,
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP
(Individ a roposing develop nt mus fill in description below or ait h a site draw
IV 1�J
f 1 5l1�11; <-
U,, i icy- e, c
N t
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish tc
the set ck, 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)
Signore 1 /
�✓ �� .cA G-1ti c�
Print or ype Name
/2 �, b ' � � fib e
A /.:I:... A--_
(Adjacent Property Owner Information)
Signature _
.rJc—
Print or Type Name /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 5T.Ji✓ t' -.Fo r d �- 4 0— d
(Name of Property Owner)
property located at f01' 4; n I L-1
on Z C 6a
(Waterbody)
(City/Town and/or County)
The appli ant has described to me, as shown below, the development proposed at the above k
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPM
(Individual development must rill in description below or att a site draN
s t �
�'tn)r +.,(4CCJ
R" 0'M C'C
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be se
minimum dis!do
a of 15' from my area of riparian access unless waived by me. (If you wish i
the setbac ,must initial the appropriate blank below.)
wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
�(Prppe Owner Information (Adjacent Property Owner Information)
Signature Si ature
�d
Print or Typb Name Print o Type Na e
),)7 lJilln, ,Abv