69149D - O'Brien

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
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.
t. Article Addressed to:
9/3 5
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3. Service Type
9590 9403 0319 5155
0 Adult 0 Adult Sgn Signature Restricted Deli
Certified Mail® Very
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❑ Registered Mail Restricted
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Certified Mall Restricted Delivery
❑ Collect on Delivery ry
Delivery
Return Receipt for
7 015 15 2 0 0002 2 2 9 5
0 Collect on Delivery Restricted Delivery
8 919 Mall
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❑ Signature MerchandConfirmatlonTm
PS Form 38� April 015 - -
2PSN 7530-02
Vail Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
-000-9053
Domestic Returri.Receipt
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C Division of Coastal Mgt. Habitat Impact Coml
Applicant: 0 1
Date: j l
Describe b_elo1 t HA AT isturbances 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
Fit
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disl
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex(
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
temp impacts)
impact amount)
temp, impacts)
am
�oL+
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: � A (I M 1) N v �) , U 8 R) e''U
Mailing Address:
Phone Number:
Email Address:
certify that I have authorized
A PI A r! C o c t-•,r%
SE) u*�Pv,,r,kC ��n�'i
!�Z/o - a,�_3 `76l
tV
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at Llga 7 K d.:5X j' M A /v
in &WV5 W/ L- County.
l 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:
il11
W;
Signature
L,)Ijrl RJ - 6, 'P R / e /v
Print or Type Name
Title

rity
a Hazard Estuarine Shoreline ORW Shoreline
(For official use only)
ERAL INFORMATION
;ss
Permit Number
Public Trust Shoreline Other _
�9 P�MC I State Zip o2 g ` hone gf Q a�3 766
Y'o a%-b e Ac le���� r . r o Nt
EIORIZED AGENT
;ss
State
Zip Phone
kTION OF PROD CT: (Addr ss, street name and/or directions to site. If not oceanfront, what is the name of the
:ntwaterbody.) #07 CT ,1� me-oasT ltI ATQ.�rk1Ay
;RIPTION OF PROJECT. (List all proposed construction and land disturbance.)
OF LOT/PARCEL: NSA
square feet
acres
*PA/U �k �sTniS
.1 04 b se -5 TA
a1.�kk-a�
'OSED USE: Residential (Single-family Multi -family ) Commercial/Industrial ❑ Other [.
PLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC app
r property):
CEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (inclu
iditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level 1
ling non -load -bearing attic space)
DASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
f SURFACES: ryl r square feet (includes the area of the roof/drip line of all buildings, driveways, covered deck
to or masonry patios, etc. that are within the annlicable AEC_ Attach vonr calculations with the nrniect drnwina

:R PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
ent system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation,
cation, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connectior,
Check with your Local Permit Officer for more information.
EMENT OF OWNERSHIP:
ndersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC
authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the p(
is landowner on this application has a significant interest in the real property described therein. This interest can 1
)ed as: (check one) (�' ` n
i owner or record title, Title is vested in ANMDljdN/ 13 /e /d , see Deed Book IQ Z2.
IqL in the County Registry of Deeds.
i owner by virtue of inheritance. Applicant is an heir to the estate of
was in County.
other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
+ICATION OF ADJACENT PROPERTY OWNERS:
;rmore certify that the following persons are owners of properties adjoining this property. I affirm that I have give
AL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name)
i
OWLEDGEMENTS:
(Address)
-7 `
idersigned, acknowledge that the land owner is aware that the proposed development is planned for an area whic
susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the parti
ird problems associated with this lot. This explanation was accompanied by recommendations concerning stabili2
i floodproofing techniques.
rmore certify that I am authorized to grant, and do in fact grant, permission to Division of Coastal Management s
al Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
to this permit application.
This the day of 120
AaAAn,.rJ 14). ,n'A2oim,.)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #,
Agent's Name #:
Agent's phone #:
or Road, City &
Mailing Address:
C
-ByL�
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.
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. 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.
C%,e JA f iu:� l� wAIVER SECTION
I understand that a pier, �ock, mooring filings, 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.
( ro rty 07.1 ner Information) (Adjacent Property Owner Information)
IU I)Nc'/ /o . 11,IgRIe,)%
Print of Type Name / r
Signature
1�'/U w GAR I a k.-t
Print or Type Name
A/_:1.-- AJJ____
AAniliniv drlrlrncc

I hereby certify that I own property adjacent to WA A Y fit. CA () (' - CA Pl e,'U's
property located at
-�-(Address; Lot, ock, Road; etc.) '
oniJ Ira Cy��%AL 04% /JA 4, in ` ✓ l:�;. 41; N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatic
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing;
S o e A71-Ac i OS
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bai
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w
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.
(Pr9perty Owner Information) (Adjacent Prope Owner Information)
n ure '' `` Si�at re
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Print or4Typa Nam Print or TYAa e
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Jul 6,
Date
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Adj�cgn�ProgertY 7Iie�Sh P/q A ^� C 1
Mai g Add ss /W I
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Receipts for
Certified Mail
(Staple Here)
City, State, Zip Code`
'-/ — -2—:s - / 2
Dear Adjacent Property:
This letter is to inform you that I, L, M b iyD W� pRliNave applied for a CAMA Minor
Property Owner
Permit on my property at I S6 4 doh n1
COUNTY Property Address
Brunswick County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s) as notification of my proposed project. No action is required from you or you may sign and
return the enclosed no objection form. If you have any questions or comments about my proposed project,
please contact me at To � 5-3,5%D % , or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Brunswick County CAMA Minor Permit Program, you may submit
them to:
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
S, rely,
/
Pni
Property Owner
Mailing Address
,-!!� , Poor , n� C
City, State, Zip Code

5T_. JAMES
• K,I A//llefllf.%ll
P,i,�,o,
tune 30, 2016
Che O'Brien Family
$427 Midshipman Ct
Southport, NC 28461
4140 Southport -Supply Road - Suite B • Southport, NC 28461
Office 910-253-4805 • Fax [phone]
�E: Section M-A, Lot 24
O'Brien Residence, 4427 Midshipman Ct
Change Request/Modification
ALL:
the Architectural Control Committee (ACC) has reviewed your submission for the following items c
:he above referenced lot.
1. Existing Bulkhead Expansion - Approved with Conditions
Provide Copy of CAMA Permit prior to project closeout.
*Property Owners must communicate the ACC's decision with the Project Contractor by supplying
:qpy of the letter for any necessary Permits from the Town of St. James or other entities.
IT n cornpletion of the project a Final Inspection for Modifications to Existing Homes form must t
>ubmitted for Inspector review. If you have any questions, please call the POA Office.
3T. JAMES' PLANTATION POA
ARCHITECTURAL CONTROL COMMITTEE

Tw/, 4, a o / I.
DateJAM ' • LT
Adjacent Property Ow
Ma jbg,Address _ , ,
City, State, Zip Code
Dear Adjacent Property
Receipts for
Certified Mail
(Staple Here)
This letter is to inform you that I, W A H #A C)4 � 1A. f P)y/ 446 applied for a CAMA Minor
��//
Property Owner
Permit on my property at li42 7 M4S %, in
COUNTY Pro ertyAddress
Brunswick County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s) as notification of my proposed project. No action is required from you or you may sign and
return the enclosed no objection form. If you have any questions or comments about my proposed project,
please contact meat 91 D- a.5 3S i D b or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Brunswick County CAMA Minor Permit Program, you may submit
them to:
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Sincerely,
PA4. 1AA ft
W . Rye
Pr(6peq Owner
7-70( ti,oM p � cT
Mailing Address
`::�OAST ,
Citv. State. ZiD Code

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PLAT OF SURVEY FOR
BILL & ROSEMARY O'BRIEN CAtA
^ LOT 24, PARCEL 'A' PUD hl', MARINA VILLAGE e,
N
a LOCKWOOD FOLLY TOWNSHIP, BRUNSWICK COUNTY O /
z ST, JAMES, NORTH CAROLINA
0' 30' 60' 120, N �
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MIDSHIPMAN COURT R/W VARIES
n
EIP S 80'48'41'
TSM - 10.66'
N 19'S0'18' E L-23.42' P
R•220.00
I9.03'
�COORDINATES-
"5029.5114
^I
EIP ri LOT 24
E-2264279.0868
BRUNSWICK HARBOR MARINA VILLAGE
PUD 'M' PARCEL 'A'
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ST. JAMES PLANTATION
ST. JAMES. N.C.
2220 PORCH S
n
17.00'
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m WOOD FRAME
ON PILINGS
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7.55,
LOT 23
LOT 25
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THE LOCATIONS OF UNDERGROUND UTIU71ES
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AS SHOWN HEREON ARE BASED ON ABOVE-
PORCH
GROUND STRUCTURES AND RECORDED DRAWINGS
PROVIDED THE SURVEYOR. LOCATIONS OF
UNDERGROUND U71UM/STRUCTURES LAY
EIP
VARY FROM LOCATIONS SHOWN HEREON.
CIP g•
'
ADDITIONAL BURIED UTILITIES/STRUCTURES
LAY BE EBNCOUNTMED. NO EXCAVATIONS
WERE LADE DURUM, THE PROGRESS OF THIS
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SURVEY TO LOCATE BURIED UTIUTIES
STRUCTURES.
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WATER +2.90'
EXCEPT AS SPECIFICALLY STATED OR SHOWN
ATLANTIC INTRACOASTAL. WATERWAY
ON THIS PLAT, THIS SURVEY DOES NOT PURPORT
'
TO REFLECT ANY OF THE FOLLOWING WNCH LAY
BE APPUCABLE TO THE SUBJECT REAL ESTATE-•
'
EASEMENTS. OTHER THAN POSSIBLE EASEMENTS
THAT WERE V19BLE AT THE DUE OF MAILING
OF THIS SURVEY; BURRING SETBACK UNES;
NOTE: PROPERTY IS LOCATED DI FLOOD HAZARD
RESTRICTIVE COVENANTS. S NIVISION RESTRICT-
ZONE 'A' WITH NO BASE FLOOD ELEVATION• REF:
IONS; ZONYIG OR OTHER LAND USE REWTIOHS
F.I.R.M. COMMUNITY NO.370295 PANEL NUMBER
AND ANY OTHER FACTS THAT AN ACCURATE AND
0360 SUFFIX 'E'DATED 4AI.
CURRENT TITLE SEARCH MAY DISCLOSE.

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PEAT OF SURVEY FOR
BILL & ROSEMARY O'BRIEN
a LOT 24, PARCEL 'A' PUD 'M', MARINA VILLAGE
ca LOCKWOOD FOLLY TOWNSHIP, BRUNSWICK COUNTY
i ST. JAMES. NORTH CAROLINA
0' 30' 60' 120'
x
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6
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z
MIDSHIPMAN COURT R/W VARIES
EIP S 80'48'41'
TBM - 10.66'
N 19*50'18' E
I"
L=2142' P Y
R=220.00'
'
COORDINATES,
�N,65029-5114
EIP (v LOT 24
E4264279.0868
BRUNSWICK HARBOR MARINA VILLAGEr
PUD 'M' PARCEL 'A'
8'
LL
ST. JAMES PLANTATION
2220' PORCH
O
ST. JAMES, N.C.
17.00' ^
$
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TWO STORY
WOOD FRAME
-
Q
ON PILINGS ,o
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W
W/ENCLOSURE ^
P
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7.55'
'" LOT 23
LOT 25
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THE LocAnar+s OF UNDERGROUND unuTlEs
AS SHOWN HEREON ARE BASED ON ABOkE-
GROUND STRUCTURES AND RECORDED DMY/NGS
Z
PORCH
(�
Q
UNDERGROUND UTW�S/STRVCCTTUREESS MAY
(1/'
EIP 1 r ~ + F.
S
VARY FROM LOCATIONS SHOWN HEREON.
EIP 8'
T !T
ADDITIONAL BURIED UNITIES/STRUCTURES
MAY BE EBNCOVNTEREO. NO EXCAVATIONS
1
I
WERE MADE DURING THE PROGRESS OF THIS
TO LOCATE BURIED UTU TIES/
N �. 0
` V•_
SSURVEY
TRUCTURES.
o
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A q EAN HIGH
�e ,..,� �-:.: ��. WATER +2.90'
aM �,ra A•� 3 cs C w .
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EXCEPT AS SPEdiTCALLY STATED OR SHOWN ATLANTIC INTRACOASTAI� WATFAY
ON THIS PLAT, MS SURVEY DOES NOT PURPORT � ., .:C✓ C�9"�"C J
TO REFLECT ANY OF 111E FOLLOWING WHICH MAY (�
BE APPLICABLE TO THE SUBJECT REAL ESTATE:
EASEMENTS. OTHER THAN POSSIBLE EASEMENTS 4�\
THAT V CRE VISIML AT SURVEY. AILOUT C TIMESETOFKMAKING �-1�'"� NOTE: PROPERTY IS LOCATED IN FLOOD HAZARD
RESTRICTIVE COVENANTS: SUMMS10N RESTRICT- / �� ! o ZONE "A' WITH NO BASE FLOOD ELEVATION. REF:
IONS; ZONING OR OTHER LAIR) USE REGULATIONS ` F.I.R.M. COMMUNITY NO.370295 PANEL NUMBER
AND ANY OTHER FACTS THAT AN ACCURATE AND 0360 SUFFIX 'E' DATED 4/91.
CURRENT TITLE SEARCH MAY DISCLOSE.

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