69341D - Todd

XCAMA / ❑ DREDGE & FILL �/`7 C � A B
GENERAL PERMIT Previous permit#
�*ew 'Modification El Complete Reissue ❑Partial Reissue Date previous permit issued'
)rized by the State of North Carolina, Department of Environment and Natural Resources Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 14, 110 (?
❑ Rules attached.
nt Name Pa �D Project Location: County I<1AY ,I nn
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64ci

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. Kim Ray Todd
Address of Property 549 Lockwood Folly Rd. Bolivia, Brunswick
(Lot or Street #, Street or Road. City 8 County)
Agent's Name #: Joel Klass
Agent's phone #: [phone]
Mailing Address PO 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_
I have no objections to this proposal. I have objections to this proposal.
P Po
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.nccoastalmanagement.net/contact 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
wish to waive the setback. you must initial the appropriate blank below )
I do wish to waive the 15' setback requirement.
r
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
)'igu�tJrn��
Kim Ray Todd
Print or Type Name
1643 Walter Todd Rd.
Mailing Address
(Adjacent Property Owner Information)
r
SigtJt�hu•e
FAST Property
Pnnt or Type Name
430 Monbrook Ln. Suite 207-208
Mailing Address
Clarendon, NC 28432
Knoxville, TN 37919-2705

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Kim Ray Todd
Address of Property: 549 Lockwood Folly Rd, Bolivia Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass
Mailing Address: PO 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 watts tt»s lever.
y 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 . :a1ni. 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
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
Kim Ray Todd
Print or Type Name
1643 Walter Todd Rd.
Mailing Address
Clarendon, NC 28432
(A cent Property Owner Information)
Signature
Diane Landis Bickers
Print or Type Name
4029 Benden Cir.
Mailing Address
Murrysville, PA 15668
City/State/Zip
. . , . /) -) r / I n " 1
City/State/Zip

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor .lames H. Gregson, Director Dee Freeman, Secretary
Date ?�
Name of Property Owner Applying for Permit:
Kim Ray Todd
Mailing Address:
1643 Walter Todd Rd.
Clarendon, NC 28432
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) pier, floating dock, and deck ,
at (my property located at) 549 Lockwood Folly Rd. Bolivia, NC
7
This certification is valid thru (date) 3�o7"J D
Z7 ��

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: V\1A
Date: IABITAT
Describe below the 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
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
Dredge ❑ Fill ❑ Both ❑ Other
q b
Dredge ❑ Fill ElBoth El(,� Other
- 1
7 LA
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑