68085D - Land

,NC Division of Coastal Mgt. Habitat Impact Computer Sleet
Applicant: Je —� L .",Vt
Date:
Permit#: G Yor6S-C
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 FINAL Feet
(Applied for.
(Anticipated final
(Applied for. (Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance disturbance.
Choose
One
includes any
Upludes any
total includes Excludes any
anticipated
restoration
any anticipated restoration and/o
restoration or
and/or temp
restoration or temp impact
temp impacts)
impact amount
temp impacts) amount)
Dredge ❑
Fill ❑
Both ❑
Other
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge [I
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
CDaits
MHCDO
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Tyler Crumbley
LPO
Tara
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge El Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge []
Fill ❑
Both ❑
Other ❑
r-fj
DW Review
Dredge ❑
Fill ❑
Both ❑
Other ❑
Owner
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ElBoth ❑ Other ❑

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Comments
Jeffery and Jeffery and
3/9/2017 Meredith Land Meredith Land NCSECU 1516 $200.00 GP 68085D SF rcl

4
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date,�—
Name of Property Owner Applying for Permit:
Jeff Land
Mailing Address:
619 Byrnes Way
Bolivia, NC 28422
I certify that I have authorized (agent) Joel Klass to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) walk with deck & boat lift
at (my property located at) 619 Byrnes Way Bolivia, NC
This certification is valid thru (date) 97
i
)'t . 'c'j

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Jeff Land
Address of Property: 619 Byrnes Way Bolivia, Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass
Mailing Address: P O Box 279
Agent's phone #: [phone] Supply, NC 28462
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.
(JD-- 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.nccoastalmanagementnet/co►nect 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
wiM��-
ve 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)
Signature
�im Land
Print or Type Name
619 Byrnes Way
Mailing Address
( jacent Property Owner Information)
%4.
Slgall e
Old South Banks Property POA
Print or Type Name
2379 Zion Hill Rd.
Mailing Address
Bolivia, NC 28422
City/State2ip
Bolivia, NC 28422
City/State2ip

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Jeff Land
Address of Property: 619 Byrnes Way Bolivia, Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass
Agent's phone #: [phone]
Mailing Address: P O Box 279
Supply NC 28462
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.
VI 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.nccoastaimanaaementnebcontact dcm.hbn 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 15from 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)
Signature
Tom Land
Print or Type Name
619 Byrnes Way
Mailing Address
(Adjac nt Property wrier Infor ation)
Signant e
Katherine Harper
Print or Type Name
40 Forest Dr.
Mailing Address
Bolivia, NC 28422
City/State/Zip
Southport, NC 28461
City/State/Zip

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19.31
2019
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1:497
0 0.004 0.008 0.016 mi
Easement-Misc Roads — NC Hwy Parcels
Easement — ate Road
Interstate f Condo 0 0.005 0.01 0.02 km
Radius Ticks '— l-Iwy Minor Ej Parcel P`-�
-_.D 6urowick County OS