68058D - Land

;CAMA / ❑ DREDGE & FILL
3 ►o? <<�
r' A B
;ENERAL PERMIT
Previous permit#
New `IModification El Complete Reissue ❑Partial Reissue
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
in environmental concern pursuant to 15A NCAC
j
—t �'
��
:oastal Resources Commission an area of
Rules attached.
1 k '
Project Location:
County
7Name
Street Address/ State Road/ Lot #(s)
State ZIP
(� j-Mail
Subdivision
.ed Agent i�.
City Iil '
ZIP
11`.�
El( CW EW PTA ❑ ES ❑ PTS
Phone # (
) River Basin
[I OEA ] HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
' C nat
�"`I
❑ Pws.
°J ,
Closest Maj. Wtr. Body ;'
f Project/ Activity
)ck) length t
.
latform(s) �1_
(Scale: �, {
Icling permit may be required by:
V❑ See note on back regarding River Basir

JC Division of Coastal Mgt. Habitat Impact Computer Sheet
Permit #:
applicant:
)ate: J (1 1
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in vour Habitat code sheet.
DISTURB TYPE
iabitat Name I Choose One
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑
Fill ❑
Both ❑
Other U
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
and/or temp
temp impacts)
impact amount)
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 ❑
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
Disturbance
disturbance.
total includes
Excludes any
any anticipated
restoration and/or
restoration or
temp impact
CDaits
MHCDO�
Tyler Crumbley
LPO
Tara
DW Review
l�
_
1�
Owner
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
In If ir-

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse 71r,
so that we can return the card to you.■ Attach this card to the back of the mailpiece,or on the front if space permits.
s+nnrr:SGPrI tn-
Seeman & Sarah Kirby
202 Holly Dr.
Southport, NC 28461
I �IIIINIIIIIIIIIIIIIIIII IIIIIIIIIIIIII III III
9590 9402 1912 6104 4429 52
9 Article Number (Transfer from service labeg
7016 1370 0000 4733 0484
PS Form 3811, July 2015 PSN 7530-02-000- 0053
❑ Agent
sale) I C. I
D. Is delivery address different rom item 1? Ye:
If YES, enter delivery address below:
❑ No
3. Service Type
❑ Adult Signature
0 Priority Mail Express®
❑ Adult Signature Restricted DeliveryO
❑ Certified Mail®
Registered MaIlT.
❑ Registered Mail Restricted
❑ Certified Mail Restr clad Delive
Collect on Delivery ry
Delivery
Return Receipt for
❑ Merchandise
Collect on Delivery Restricted Delivery ❑ Signature ConfirmationTM+ "--ed Mail
'red Mail Restricted Delivery
)r $500)
O Signature Confirmation
Restricted Delivery
Domestic Return Receipt
W
N
O
T0C
ch Cn
Q -0
to
0
3 O
c�
0
m
O
3
r
N
7
a
C
W
U
W
N
A
N
O
A
O
CO
rfl
N
O
69
N
O
O
O
O
G) (�
� O
O
O
C.)n ft
Co
C rn

e��
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 Feb. 12, 2017
Name of Property Owner Applying for Permit:
Tom Land
Mailing Address:
6320 Shelf Rd.
Marshville, NC 28103-7826
I certify that I have authorized (agent)
Joel Klass
to act on my
behalf, for the purpose of applying for and obtaining all CAN'IA Permits necessary to
install or construct (activity) floating dock, ramp, and boat boat lift ,
at (my property located at)
PI # 235JM00102 SE 23rd St. Oak Island, NC
This certification is valid thru (date) / 1,—,,-2z) 7

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner Thomas Land
Address of Property SE 23th St. Oak Island, 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 1 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 areposing. 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. Contact information for DCM offices is
available at t; ;.^^ .nccoAsts:r?ranauarr entneJcorrtaC dcm.htrr, or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been noted 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 )
7��o wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signatni-e
Thomas Land
Print or Type Name
6320 Shelf Rd.
Mailing Address
Marshville, NC 28103-7826
Clty/State/Zip
(Acjjacent Property Owner Information)
��ahn•e
Steven L. Thomas
Print or Type Name
1021 New Dover Rd.
Mailing Address
Apex, NC 27502
City/state/zip
IT 1-1 --1 11 el cl I (—