63121D - White

LAMA / ❑ DREDGE & FILL
;�NERAL PERMIT Previous permit#
;New ❑ Modification ❑Complete Reissue ❑ Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f/ �� Rules attached.
Name
�2 Grj
tate� ZIP_
()may Fax (—) ,.�--
ed Agent fe
❑ CW [,J W G?VTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes /:rto PNA yes
Pro
.ect/ Activity _
ck) length
,ier(s)
ngth
tuber
d/ Riprap length_
g distance offshore_
ax distance offshore
hannel
bic yards
np
is Wz�'
2
lulldozing
ie Length
notsure yes
gs: not sure
yes
rium: n/a
yes
yes
�A'ttachedd:
Gng permit
may be re
❑ FC:
Crit.Hab. yes / no
Project Location: County AlAho--_e3 �
Street Address/ State Road/ Lot #(s)
Subdivision
City &Wle"l ZIP;/6
Phone # ( ) River Basin
Adj. Wtr. Body l'e5
Closest Maj. Wtr. Body
(Scale: / ,fie

)ticant:
t:
e/
Permit #: 5 ( z /
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat Name
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
includes any
disturbance_
Excludes any
Disturbance
total includes
disturbance.
Excludes any
Choose One
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 El Both El Other
�jv
�g
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
I
•MPLETE THIS SECTIONCOMPLETE
THIS SECTIO N ON DELIVER
■ Complete items 1, 2, and 3. Also complete
❑ Agent
Item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
�
❑ Addressee
*B.by(PInted Nam
C.
Date of Delivery
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
ks a? t'r
or on the front if space permits.
D. Is delivery address different from 1121111111 T
If YES, enter delivery address below:
A
❑ Yes
❑ No
1. Article Addressed to:
/
11is/hf'X1—
11
t,)*/wL ,
F2 CVVE
�E� [
3. Service Type
IN DCM WI ON, NC
❑ Certified Mail ❑ Express Mail
❑ Registered ItRetum Receipt for Merchandise
17 2013
❑ Insured Mail /❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
2. Article Number 7 012 1010 0001 9023 8 311
(Transfer from serv!
PS Form 3811, February 2004 Domestic Return Receipt
t -M-t540

OPERATING ACCOUNT
2580
109 K 6PH 910-256-8774
109 KINGG ART ARTHUR DR
�� 66-112/531
WILMINGTON, NC 28403-0347
Date
Pay to the �/ C j'� /
Order of � � Y
$`w-
Dollars
BRANCH BANKING AND TRUST COMPANY Fe&�q'
1-M-BANK BBT BBT.00m ..... c o L u
For t��l�c� /✓K, f
1:053 L0 L L 2 0:0005 20 2069454u'0 2580

IAL SURVEY OF
52 PELICAN DRIVE
LOT 9 CHANNEL ACRES
TOWN OF WRIGHTSVILLE BEACH NEW HANOVER COUNTY
NORTH CAROLINA
DATE: NOV. 19, 2013
REFERENCE: DB 4952 PG 2971 MB 9 PG 27
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LOCATION
( NOT TO SCAT
SIDE 01
PE VgN,
US 71
PIER HEAD LINE TAKEN FRC
THE TOWN OF WRIGHTSVILLE
BEACH PIER HEAD LINE MAF
(SHEET 7)
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MARTIAL SURVEY OF
52
PELICAN
DRIVE
.OT 9
CHANNEL ACRES
TOWN OF WRIGHTSVILLE BEACH NEW HANOVER COUNTY
NORTH CAROLINA
DATE: NOV. 19, 2013
REFERENCE: DB 4952 PG 2971 IB 9 PG 27
E 6�
NEAP LINE .��, p v 1
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old w l 1 � 7-
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LOCATION
( NOT TO SCAT
SOC 01
PE \\5PA
US 7E
PIER HEAD LINE TAKEN FRC
THE TOWN OF WRIGHTSVILLE
BEACH PIER HEAD LINE MAP
(SHEET 7)
cul
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o I� �
1 coE1 z 1 11
�IZn 1 I LINE BEARING DISH
�I 11 1 BU NEAO 1-1 IN 76-08'45" E 61
1

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property.
/t q Attpkt- W d &
02 �� l t e69� Kj Lam. , O/u 5 ' s u,/4e_ / r , , ill ew,
(Lot or Street #, Street or Road, City & County)
Agent's Name #: _ _ �hf'/ Mailing Address: Id 7 Alm W/ZL
Agent's phone #:
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
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 9 )-
S 1 LtGtot, I d 4l,te
Print or Type Name
S-�)pe lied biu�r-
Mailinn Arflroec
(Adjacent Property Owner Information)
Signature ,/�
/'7 � 8tJ-1/1fqAC—
Print or Type Name
J0lS,3AJSkfi-e64,
.._ .

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: :5 A H 12yi�rL
k, I L
Address of Property. 5-1 e lI e- .4t- n j�
l�k, vi%le �3e�
(Lot or Street #, Street or Road, City & County) �1icv- C
Agent's Name #: rske A /-
Mailing Address: /09' /� i�� "40A_
Agent's phone #: S,��t 4` y y SIQ I J, l0, e.
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 d awing 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 ob "action if ou 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. i-n i+s en+t'rt c) .
I do Zfprove a 5 Foe-t- encrozc,h�v+n•�+ �i1f-o -I-he sotb��
Mr 4-he a-N'achGcj s1�Ge-1-cl%
(Property Owner Information) (Adjacent Property Owner Information)
Signature
Print or Type gName
,S�- %fit' l !C!H ice• /��iL1 L�
Mailing Address
�1
S nature
Print or Type Name
S-q /tee11,
Mailing Address
is

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIOWWAIVER FORM
Name of Property Owner j /t )q Ahglti W, /--1
Address of Property: 5-a Pe-1 1e6 , %��1�1� , W/u�G u,%�� ?
(Lot or Street #, Street or Road, City & County)
Agent's Name #: 6yr /�-kj��
� Mailing Address: %% A/ �/2W-u,1
Agent's phone #: S7.-O - -/q
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 descri bon or drawin with dimensions must be Provided with this letter.
L hU v�u� , ��rs n s oj� -C l
Uhs C--,, Se C S n�J
I have no objections to this proposal. V, have objections to this proposal.
If you have objections to whatis 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 Certifteid Mail.
zC
WAIVER SECTION
II derstand 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) (Adjacent Property Owner Information)
Signature ) Signatur
6 � 141 tttoc- u/ kl t�G
Print or Type Name
S- f e l eNt- bK&-e-
Mailing Address
Ine- �3 1
Pr nt or Type Name
Mailing Address

w� A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. SI
Governor Director Secr
AGENT AUTHORIZATION FORM
Date: %7 — 13
Name of Property Owner /Applying for ermit: Name of Authorized Ag nt for is project:
Lt lta�'w` / ' l ,
Owner's Mailing Address:
Phone Number ` //
Agent's Mailing Address:
Phone Number /o T-- 0 — 7
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits nece .sary to inst II or construct the following (activity)
l�� Li /3 � t+4 - l , �� 4- lk-d� old 4, 11
For my property located at
This certific4tion is valid thru date)
Prop6irty 0*1ner Signatu
f. :3 (1l3
-/7-'/3
Date
;�;� t