66505D - Sunset

CAMA / L DREDGE & FILL I C L (/ : A B i
fEI11ERAL PERMIT Previous p
�/ d ermit #
Vevo ❑Modification []Complete Reissue El Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources �}'`)
�astal Resources Commission in an area of environmental concern pursuant to 15A NCACy ! 1i �E]JRules attached.
Name `` Project Location: County 1
ISM CT N.1S t3� a t. ,d S�nn52i` I��d i" j,� Street Address/ Statel Road/ Lot #(s)
Q.state
LO) 5-161 -00o 8 E-Mail Subdivision
��
ad Agent ,�^� 7 a V 1 (6( City 4*7w \5__f_� 1 ��' (" ZIPa_�(
# River Basin
❑CW ❑EW [I PTA XES Phone (1
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body �� (nat /r
❑ PWS: (�
Closest Maj. Wtr. Body
yes /, no PNA yes / jno)
Project/ Activity
ck) length
g distance offshore 0 r—
ax distance offshore O
hannel
ibic yards
s
mp,
4e/ Boatlift
3ulldozing
Ac CA,
ne Length
cr'f'Iw(
01,
not sure yes
)rium: n/a yes gn +
yes no -....... - - i
Attached: yes no �jQ
ling permit may be required by:
Local Planning jurisdiction),-
(Scale:
❑ See note on back regarding River Basin
_ \ — In- . —L. `' \ f)(0"

NC Division of Coastal Mgt. Habitat Impact Con
Applicant:C�,•�-�(,G�/�/,
Date: (Y�/C , f
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
F
(Applied for.
(Anticipated final
(Applied for.
(�
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
d
Habitat Name
Choose One
includes any
Excludes any
total includes
E
anticipated
restoration
any anticipated
rf
restoration or
and/or temp
restoration or
t(
temp impacts)
impact amount
temp impacts
a
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 0 Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: iowO d� Sc,hS�� 1/72rcc�,
Mailing Address:
Phone Number: �l(/ — 5 %y - 6gq l
Email Address: t ii r
6�hioc
I certify that I have authorized T0✓ Vl A S �A H Se euc
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: J J i T, u nC'
at my property located at g (d'�.e
in LiAhi 111L h 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
J�AMP '9 , C-o A
Print or Type Name
Title

.��►5►ai1/l�la►lll/.�11
Ms. Sarah Nahory
5308 GUildbrook Rd
Charlotte, NC 28226-5807 F
ios e�sewicr.
1000
7015 3430 0001 1347 9815
Al c '�Z) " v )- 's I' o k--� f
f ;Z 7 C-a
wl,
! r-n i h 7 N c-
U,S.A� OSTAG E
CHPPARLDDOTTE, NC
28211
APAAMOUINT
28405 T 6' "7
4
R2303$103626.16
Co�s��lay�a �rn�
,�gLl-o 5 — 32 9-'s

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: �Ul/i� y �� ,-4 ire 1J yj iA S7 , � � d0 I
(Lott or Street #, Street or Road, City &County)
Agent's Name #; r/lam v� � �r 1 h f�-� � �, Mailing Address: _ �(%() ,) c� ySQ � L���.
Agent's phone#: Of oZ�(Cj��
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.
�t- I have no objections to this proposal. I have objections to this proposal.
r1 �-
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
V considered the same as no objection If you have been notified by
Certified Mail.
I understand that a pier, WAIVER SECTION
p 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.)
5 I do wish to waive the 15' setback requirement.
1� I do not wish to waive the 15' setback requirement.
(Propertv Owner Information)
SSzz�n
i'gnafw•e
Print or Type Name
Mailing Address
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
Cf 49sz'

s
z.:
a
l
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i

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner: J,
Address of Property: P, U,, e j 11% � � 4/''G � I a % G �n • r.11, u �, ! o� �jE t � ���zP �
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Ivwti v S�, AiLJ �`?�uc� Mailing Address: ?6� ki
Agent's phone #:
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 drawin4 with dimensions must be provided with this letter.
V_ I have no objections to this proposal. ] 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.
(Property Owner Infor ' ation
Signature
%J L
Print or Type Name
(Ad j 7=ron)
Sign
s�,� 41 h
Print�t or Type Name J l!}�/
L 1 ( CO
Mailing Address
Mailing Address

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toll
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r` Postage $
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flu Certi)ied Fe= Postmark
p Return Receipt Fee Here
Q(Endorsement Required)
Restrictedem Delivery Fee
p (Endorsement Required)
-n Total Postage & fees y%
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Ciry �-:•--- - `-•_.-
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State ZIP -~ p_. ✓C � �� L
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)mplete items 1, 2,'and 3. Also complete
om 4 if Restricted Delivery is desired.
int your name and address on the reverse
i that we can return the card to you.
tach this card to the back of the mailpiece,
on the front if space permits.
ticle Addressed to:
All
1 r
A. Sig tune �'
ffjAddressee
B. Received by (Printed Name) C. Date of pelivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
�f Certified Mail® ❑ Priority Mail Express"
0 Registered V Return Receipt for Merchandise
13 Insured Mail 0 Collect on Delivery
4, Restricted Delivery? (Extra Fee) 0 Yes
tnsferle from
7009 1r68O 0002 3797 2733
'�ansfer from service label)
orm 3811, July 2013 Domestic Return Receipt

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