76417D - Jordan

(LAMA / ❑ DREDGE & FILL N9 76417 A B
e""ENERAL PERMIT Previous permit #
ew —Modification ❑Complete Reissue Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environmental Quality / / '
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /`% GV o
J , � ❑Rules attached.
it Name I To ` Project Location: County �r u ✓� RI J I G �
Street Address/ State Road/ Lot #(s) 1 6 62
State N (-zip �Wbs
( ) E-Mail WrJpV\ Nr, k&Ua GD-C°subdivision
zed Agent CityDa I�- ZIP Z
❑ CW 'El
A ❑ ES ❑ PTS Phone # ( �� River Basin
ElOEA ❑ HHF t IH ❑ UBA ❑ N/A
❑ PWS:
f Project/ Activity
>ck)length
'latform(s)
Platform(s) -/
ength
ember
ad/ Riprap length
ig distance offshore
iax distance offshore
:hannel
ibic yards
.MP
use/ Boatlift
3ulldozin /
U
ne Length 4— � —
not sure yes
mum: 0yes
no
yes
no
Attached: yes
no ,
Adj. Wtr. Body
Closest Maj. Wtr. Body AT
(Scale:
1 !�T Da JC- —T—(- /$41 ❑ See note on back regarding River Basin
ling permit may be required by:
. I n—1 Plnnninc hiricArtinn\. .

.LAMA / DREDGE 6 FILL ! V �? ?fi i , q 6 C
GENERAL PERMIT Previous permit#
�
YNew Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina. Department of Environmental Quality
and the Coastal Resources Commission to an area of environmental concern pursuant to I SA NCAC 7, t "'i _
R-lies arr<iched. j�
Applicant Name r� IR"I -�t�? JOLO Project location: County rL4 r\ S A (Gr'
Address ttl e Street Address/ State Road/ Lot #(s) to ✓� { �dC/t.
City State t �` ZIPU� y�
Phone # ( t E-Mail WfAA,*,,Oct l'\&kA4X, (''Subdivision
Authorized Agent City �� �c jj'!tu'd ZIP
Affected Cw tiEw �PiA Es PTS Phone # i _-I--1 River Basin
AEC(s):OEA HHF iH URA NA Adl, Wtr. Body + J�
/man•
PWS J
-
i
ORW es ;.'"•x.`yPNA yes�i no Closest Mal. Wtr. Body �}
I Type of Project' Activity
1
(Scale:
' fixed Plat c.r, �
Floating Pfatf - -'�-
Finger pm.
Uro;n k g-,h
number
Bulkheads Rrprap is gth
avg clstance cffsho
rear. dwance cffshcrc'
Balm. rhanne
�r
gut t fa-d
Boat ramp
BaarhouSr-`
! V l
Beach Bundoz:nahtr
g
Sborehne
SAV nc sure yes rr.o / jj / C
.1 J
Moratonum .rt' yc.. L -... CJ ` .... -tV` -L
Photos yos
Waver Artar,hed ye: oo •� .
A building permttmay be required by: Note Local Planning ju-dictr See noon bark regarding River Basin la
( m� � �
te
Notes' Speaa} Conditions 1 �� F ` l a '

gt�;NT AUTHQRI�,A 7IAN.FCJ,,� CAMA PERMIT APPLICATION
�:. .. Nawe cf Propery Chvner Requesttttg P'3rm,t.
1 r r �rz 11✓�
Phone Nc,n,0er:
�racFB
Email Address:
1 enjiv that; have atHhonzed
age^t /contractor
to act an my behalf, for the purpose of applying for and obtaining all CAMA permits
neces_-ary for the following proposed development:
at my propeity located ar
In l'rbct,.�t_%r'<r County
t furthermore certify that I am authorized to grant and do in tact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection vnth evaluating information related to this
permit appiication.
Property Owner information:
t
r' or Type Alan;,, -
This certification is valid through

JAgr:NT RIPARIAN MOpERTY OWNER argT uFNr
1-�rebY cerNty that 1 adjacent to
1,✓ 's
a'operty locatnd at (N" of PropaAy I ner)
Block, Road, au.)
(Warcrbodp)- - '� ,. _ - N.C.
(City ownandlorCounty)
Thra epptirant has oescnbad to me, as shown oslow. the development proposed at the above
iocauon.
I have no obiedion to this proposal
.—._...w--- t have objpr,Mons to this proposal
DESCRIPTION AND— DRAWING OF PROPOSED DEVELOPMENT
!fnoVyiN,ual prcy'osrno !Jevelopment must fill in dgscypdM below, or attach a site drawing)
i understand that a pier, dock, moonnWAIVE�N
must be set back a mrnimur„ dirance o159fromom ramp breakwater, boathouse, lift, or groin
me !tf you wish to waive tt� setback you must Initial the aof riparian access unless waived by
PPropriate blank below )
---__= I do wisn to waive the 15' setback requirement
i do not wish to waive the 15 setback requirement
Property Owne Inftion)
1 (Adjacent Pr9�Jy Owner Information)
A,
✓f
CM4/ tate2rp
u4744Iv /
Te/eP.ho,7e 411mber/errrail add,ess �✓Hj(dr1.r.Jr�
.
a :_2 c
Date
r
_._---
Valid for one calendar year after signature'
Pon. or T37,p Name
�r. . �•:;Li
Maitin Addrgss
CrfY' 1
F d3--S'/$-:Z6''Y'.�
Telephone Number/omad address
(Raviged Aug. 2014)

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: JQm e 5 J O
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street i, Street or Road, City & County)
Mailing Address:
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.
have no objections to this proposal. I have objections to this proposal.
,vZ
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 Mall
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.
(P opertyOwner nform ion)
gnature
J a M e J0
Print or Type Name
0� Y/9
Mailing Address
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
11A-. i

Ch—k
sa
C.1-4
Ga Sample/Jonathan Riley
Columns
BBST
CW-6
6563
1 COA-7
400.00
I
GP #76101D _
coaomrra
_ JD Mt 10196
in LLC
Simon and Adrienne Medley
_
- Wells Fargo
_
_
5491
200.00
GP #74656D _
PA rd. 107 11 _
_
2483
3155
$ 200.00
$ 200.00
_
Imo_ _ same South State Bank
Mark and Carol Tallon First Citizens Bank
GP#76527D
GP_#76197D
,PA rcL 10764 _
BB rct. 10473 _
Des LLC
Debra Eichorn PA Elsie Cumbee
FCB
3158
$ _.. 200.00_
GP #76421D _ _. _. _
Bbrnk rct., 10441
i
LYq LLC
Jim Jordan
.James Minett
_
Bank of America
FCB _
_ 6190
_ 3156
$ 200.00
$ 200.00
I GP #76417D
GP#76406D _,
Bbrink rat 10443
Bbrnk rat. 10442