67286D - Sanford

+CAMA / El DREDGE & FILL A B
"ENERAL PERMIT Previous permit #
(flew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized 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
uy ❑ Rules attached.
t Name NKCProject Location: County
t2-7 L�7 , Street Address/ State Road/ Lot #(s)
f A a State *JC ZI P rz�, F� K.5
('�� E-Mail Subdivision
:ed Agent N\* i� '(�- -!�7 f -Vu , (A-f! N IY-)N &r WCCity# & P A j' I zip Z `q
❑ CW ❑ EW ❑ PTA '-, ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes / no
Project/ Activity
length
ngth `
tuber
ikprap length 4_s o
: distance offshore
x distance offshore--n>1
cannel
Zic yards
1p
se/ Bo�tih
illdozing
Length Yt/ In
not sure yes
um: n/a yes
yes
ktached: yes �o
Phone # () `Fzyt E River Basin 0="1
Adj. Wtr. Body \J t' E,IN I A CIPE aal
Closest Maj. Wtr. Body `�`'(-- . 191)LA Pj�-
(Scale: I ttZ� C
ig permit may be required by:
-ocal Planning Jurisdiction) r-7
❑ See note on back reRarline River Basin rt,

NW omsion At !f®ial�v�it1 ./�r1b�16a 9AGflRiltloa.e papa Rvw.-r— -
Applicant: �d
Date: 1p3,�j
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 $4. Ft. FINAL, Sq. Ft. TOTAL Feet FIN.
(Applied for. (Anticipated final (Applied for. (Ant
DISTURB TYPEDisturbance.total' disturbance. Disturbance dish
includes any, Excludes any total includes Excl
Habitat Name' Choose One anticipated restoration any anticipated rest
restoration or and/or temp restoration or temi
tempimpacts) Im act
�amount tem ini acts amc
ti Dredge ❑ Fill ❑ Both ❑ Other
Dredge Q
Fill Q
Both. Q
Other ❑
Dredge [I
Fill ❑ :
Both .❑
Other
Dredge ❑
Fill Q
Both ❑
Other [Q
Dredge ❑
Fill Q.
Both ❑
Other ❑
Dredge Q.
Fill ❑
: Both ❑
Other ❑
Dredge ❑
Fill 171
Both ❑'
Other

1ck Proccessing
ifirmation
e Received 1 10/31/2016
ck From (Name) Brandon Grimes (Money Order)
ne of Permit Holder Joanne Sanford & William Brewer
idor Western Union
,ck Number 17-491423201
,ck amount $200.00
tiple Permits No
or/Minor
mit Number/Comments GP 67286D
:eipt or Refund/Reallocated JD 2798D

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 63 f a0 1 b
Name of Property Owner Applying f9r,Permit:
I\v 4-b
Mailing Address:
I certify that I have authorized (agent) 1'i e S to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)e i !Mw w�iq-t
at (my property located at) r_v 13 k- tie
This certification is valid thru (date) ec . i Zp i la
Property Owner Signature Date

0
07' t_ C-1 I G k" i) s / v 1,4 Jy )
1,91
� a 50t,-' t- ✓2 v o( � b -,-y -,"P))b

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to, A6 4(.
—� (Name of Property Owner)
property located at Le, ; , l'- 'Z !;, n h.,,, L� �,, -N<.
> (Address, L t, Block, Road tc.)
on t (< in -' ,
i � n-, . N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
7---
1 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)
e-:;rt"t (i i
l Nipp a-,,, . LAZE i" y�
t.� C EIVE®
OCT 3 12016
DCM WILMINGTON, NC
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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature Signature*
Print or Type Name Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ; o w\ s
� (Name of Pro��rty Owner)
property located at Gt n & S
(Address,
on )4;,� )i C�Ce� in.
(Waterbody)
Block; Road, etc.)
ity/Town and/or County)
N.C.
The applic nt 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)
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.
I do not wish to waive the 15' setback requirement.
(Prope Owner Information)
Signature�
ly, �I" w, &',
Print or Type Name
(Adjacent Property Owner Information)
4
Signature
Print or Type Name ,

109. Site
Osj 6
<�
�F--Iv Ln
VICINITY MAP N.'r.s
Scale: 1'= 60'
�
'a' w v e' ��
-Ilk
Lot 13A
1.53 Ac.
1.414
m
a
0
a
.
r
l
vv,& v
f
�3
1y
1
\ Y \
1ID
\ CI
1
LINE TABLE
LINE
I BEARING
LENGTH
L7
N 21'49'15" W
89.81
L2
N 50'44'20" W
55.52
L3
N 27'39'13" W
24.49
L4
N 06'49'36" W
55.60
L5
N 21*49'15" W
160.68
L6
N 54'23' 1" E
12.64
L7
N 81'47'39" E
115.07
L8
N 43'09'34" E
100.57
L9
N 54'39'27" E
79.46
L10
S 40*04*39" E
56.92
L11
5 00*40'38" W
97.88
Lit
S 17' 4'11" W
150.72
L13
S 65'00'16" W
28.43
L14
S 40-12'31" W
78.68
L15
S 30'01'56" W
38.42
L16
01-46'10" E
53.83
L17
S 01' '10" E
43.75
Lot 14A
\
Redd Banks on
Virginia Creek
MB 39 Pg 10
Lot 12A
\
Redd Banks on
Virginia Creek
MB39Pg10
\
\
\\ f01N
SURVEY FOR:
Matt Esteves Construction Corp.
Redd Banks Lane
PrPliminnry