76508D - Darden

ICAMA / E'YDREDGE & FILL
xENERAL PERMIT
INew ❑Modification ❑Complete Reissue ❑Partial Reissue
N° 76508 A B
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environmental Quality b > (
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rul attached.
Name / Project Location: County. f/VI
6 1 1 Street Address/ State Road/ Lot #(s) y
a. 1
Q a State �4Ll P�
(i b )7,Y_ 00 ;�L E-Mail Subdiv
ision
sd Agent City —L` I��IF �(t�, ZIP
❑ CW fW $;PTA �El PTS
❑ OEA � HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
;/%?i& PNA yes / no
Project/ Activity
igth
nber
PXprap length
distance offshore
c distance offshore
annel
is yards
P 12 V
Length 'r
not sure yes //nn
gym: n/a yes
yes
ttached: Ic ne
Phone # ( ) River Basin V✓ I 1
Adj. Wtr. Body C(natefi
Closest Maj. Wtr. Body
%" '�:7.1,f
(Scale: z
g permit may be required by: vl ❑ See note on back regarding River Basin
ocal Planning jurisdiction)

Name of Property Owner Requesting Permit:
Mailing Address:
And\1 Jlie P
Phone Number:
Email Address: �c n hnUPr1lI tG�en� Ci ��v► /t n v�
I certify that I have authorized
Agent / Contractor
to act on my behatf, for the purpose of applying for and obtaining all CAMA p6rmits
necessary for the following proposed development: �% / .�e�i
-- 4u X 41 �a1 allc tf rQ 111 b
at my property located at
in
County.
l furthermore certify that l 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:
Signature
�e
P t or Type Name
Tine
I �� ljj

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: And
Address of Property: M� l 1 t �0 n„510 W
(Lot or Street *,/Street or Road, City & County)
Agent's Name #: E1 l ncf� Ma/ e C�Oi "Mailing Address:
Agent's phone#: q to - M%141-15 ,Snesak Ferri, Nc A 8'!!�6
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 thislletter.
>, I have no objections to this proposal. I have objections to this
If you have objections to what is being proposed, you must nottfy 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.
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.)
t` 1_ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr perty Owner,formation)
Signature
Print or Type Name
Mailing Address
(Adjacent Property Owner Infonrstion)
Signature
Print or Type Name
?)T RQ'4g/
Mailing Address
'�Qf a f. /'k -t �J-2-a

m —
Nam. oI Permlf Holder
Vend.
Ch-k (AVOW
amount
Pw ft NumB.r/Comm.nb
R.al t or Refun&R..Noc.t.d
—3
Column/
CW,mn6
Cdwmo
Coklmn7
Columns
Caknnn9
same
Suntrust
65081
$ 200.00
$ 200.00
$ 600.00
$ _ 200.00
$ 600.00
GP#76506D
JD Mt 10229
An
awns
FCB
8987
GP R6507D
JD rcL 10230
AmN Darden
Coastal Bank wnd Trust
3113
GP 97WWD
JD rcL 10231
Suzanne
Branch Bankmg and Trust
36773
GP R6416D
Ban rcL 10440
Michael Yarn ino
FCB
1081
GP R5815D
Ban rcL 10447
same
UMB Bank __
fC_ B
astal Bank and Tru
1221
E 200.00
GP R8402D
Ben rcL 10446
Dawn Greer
2174
S 200.00
IGPOM551D
I JD mt. 10233
lMn Rose

17
1
Awl OIN
1
I
f"*S tsl 12 D1
i�

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner-,
Address of Property: /,� l i_S� SAC e-t 5 o r+ b -f 4 Los uj
(Lot or Street #, Street or Road, City & County)
Agent's Name #: EnnC-4 MJJrJ n 6 �� Mailing Address:
Agent's phone #: �t jC - �'� i�r�� �4 J SIC S ire rui..
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 f0 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 28405-3845, DCM representatfves can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
1 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 requiremert.
I do not wish to waive the 15' setback requirement.
{Pr Owner Inf tion) (Adj cent Pro rty Owner Infornation)
innu re Signature
or Type 4ame
_3c& -72�le-144 A
Mailing Address
Pr(nt or Type Name
Mailing Address
G -, / !. . Vr -.,