65180D - Buffkin

6CAMA / E DREDGE & FILL
3E'VE13-4L PERMIT
New odification ❑Complete Reissue
Previous permit #
El Partial Reissue Date previous permit issued
rrized 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 1/" H
ules attached
it Name W Arw
�,A 723-47 State &t ZIP `Zg'yo f
( �) .23 /45/l/ Fax # ( )
ted Agent 7I -lik" y
?'CW � W { fTA ❑ ES ❑ PTS
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
J PWS: ❑FC:
Project Location: County AAw �►(>✓��
Street Address/ State Road/ Lot #(s)
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City V1//r��i1YJ1//� ZIP''
Phone #
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yes / no PNA hes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
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ing permit may be required by: �f� �d . �hl�fi/G/s3� / . ❑ See note on back regarding River Basin r

utrvrc k HmA uauy t neCK Log ror vvircu
Date Check Check
Received Check From (Name) Name of Permit Holder Vendor Number amount Permit Numbers
4/9/2015 Coastal Marine Piers Bulkheads LLC Willard Buffkin & Kevin Dolan Wells Fargo Bank 20060. $400.00 IGP 65180D & GP

NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: k11111ml1�6(q�flvl Permit #
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
found in your Habitat code sheet.
-iabitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fir
disturbance.
Excludes any
restoration anc
temp impact
amount
Lod
Dredge ❑ Fill ❑ Both ❑ Other
671
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yy
Dredge ❑ Fill ❑ Both ❑ Other V
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge 171 Fill ❑ Both 0 Other ❑

Facsimile Cover Sheet
date:_ -? " '-r �-0 ?
to: 9�b M 0� ,
from:
re:
# pages(including cover):_
fax #:
commentS:
If you do not receive all pages please contact the sender at [phone] or fax
(910);199-1332.
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ARIULCE R1pAR3A11! pwm.OWNii ST®,JENT
I hereby 0MA' dust I own property adjacent to �,{- � 'a
� t /q Q �. NoeofIMF )
,r.
on N.C.
(V1latetbCxiy) (Cajr/TOwn andlorot►ntYj
The appkattA has deacn-bed to me, as Mown mow. ft deVeiopmWA proposed at ft above location.
I have no of jek n to this proposal.
_ I han objedons to ft proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED D£YRLOPIMl;EW
(lr duW wwd>tittg davdapmwt mart fo in dwavg to below or ~ a aft drams ng)
WAIVER SECTION
I ur►eerstand that a pier, dock, moo(ov pllivs, breakwat*r, bashWe, lift, of groin m be sot Back a
minimure Mw%rwe of IV from my area of riparian wxess unless waived by me. Of you wish to waive
the seftck you must
'i�n""the appropriate blank Wow.)
4r, & Wish to waive the 15' seftok t-+aquiroC1' ant,
I do not wish to waive the 15 setback requh'smerk.
(P awcWtr ln*wrtadon} (Adjacent Property Owner Inn onra don)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to &J,, lln' tl'-i fil '-'J 's
(,Name of Property Owner)
property located at 7�'
on ZeJtJ4,`,->t l (Address, Lot, Block, oa etc.)
,Na in N.C.
(Waterbody) (City/To n and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Se,e- aW C,�,eO/
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.)
/ CFI
S ✓ 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si at
Print or Type N me
63/qG')VI,C U-i/ //L)
(Adjacent Property Owner Information)
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ADJACENT RIPARIAN PROPERTY OWNER STATeMEN
hereby certify that i cwn properly adjacent to coo ; `t ,. � � � ,''� _'s
`� • (Name of Property Owner)
property located at
(Address, Lot, Block, Roari, etc.)
on _ _ r`c �`!D.< , to -c, N.C.
(Waterbody) (CitylTow dlor County)
The appl' -, ,nt has descried to me, as shown below, the development proposed at the above locat-or).
✓ ! have no ob;ectio . to this proposal.
; nave objections to this proposal.
DESCRIPTION AND/OR DRAWING OF -.C. DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
UCM WILMINGTON, NCB
APR 2 1 2015
WAIVER SECTION
understand that a pier, dock, moo..rg ilirlg , breakwate, boy ir: se, sir. r�.:+st : A .• ba:, a
minimum dlstanre of 15' from my area of riparian access uniam'uaived by me. 'if yc-. to waive
the setback. you must initial the appropriate blank below.)
rl . I do wish to waive the -15' setback requiremew.
J
I do not wish to waive the 15' setback reel+uite,-,er+',.
(Property Owner Information) (Adjaceent`Pro(peer*u Owner -Information)
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Print cr Type Name Print or T,a Name
>< r,✓. - , t-, , S �9- 3'U
UaNng Address'(. _ ` '

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
/ r
'I hereby certify that I own property adjacent to �; &VO/ ulc r -�' 's
P r {Name of Property Owner)
property located at r o,
P(A jdress, Lot, Block oaf , etq
on �P to,:.�� �,�a l , in (1AJ, I c. I - -J , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
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)
RECENEE
[)CM WILMINGTON. N("
WAIVER SECTION APR 2 ! 2015
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
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.
Print or Type
1
ype Nafn e
'3l f � i ty[�.S LI , �� J
(Ad'Property Owner Information)
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Sigl3ature
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Print or Type Name

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