74817D - Keene

AMA /.<DRED E & FILL No. 74817 A B
3ENERAL PERMIT Previous permit#
dNew Modification ]Complete Reissue El Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environmental Quality /,[
Zoastal Resources Commission ina(% n area of environmental concern pursuant to 15A NCAC �/�, mo 0
O Rules attached.
it Name e--tA_Q1 Project Location: County UN� L t9 D✓
Z %b / Street Address/ State Road/ Lot #(s)
�j v/ z State N(— zip 156�'
f ( �� Z 3 ai14 Subdivision .
Eed Agent City 1'/ F T ZIP �� L
❑ CW D EW ❑ PTA )WES Phone # ( T— ' River Basin (f`�
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body L Q �7` / 1/�!✓ nat
❑ PWS:
yes / ( no PNA yes / o Closest Maj. Wtr. Body
f Project/ Activity
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ing permit may b ere quired by: ❑ See note on back regarding River Basin r
Local Planning jurisdiction)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �0 Ye, e4l-e s
(Name of Property Owner)
property located at
(Address, Blo ad, )
on , in _ C.
(Waterbody) (Ci own and/or County)
The applicant has described to me, as shown below, the development proposed at the above location
6-�r_ 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)
Z�
WAIVER SECTION
I 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 waiv
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.
(Adjacent Property Owner Information)
77e
I,F/-r2

I hereby certify that I own property adjacent to
property located at — -4D A, A
(Address, Lot,
on _( r� S , in
(Waterbody)
RTY OWNER STATEMENT
1 hn kr-e-^ � s
(Name of Property Owner)
(City/Town afid/or County)
.C.
The applicant has described to me, as shown below, the development proposed at the above location
96— 1 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)
l x,41 1 � i✓,
Tot
WAIVER SECTION
I 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 waiv
the setback, you must initial the appropriate blank below.)
1 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)
Si tur Signat re
P nt orType Name Print or Type Name

I i 0111,11;lI��
Name of Property Owner Requesting Permit:
Mailing Address: O
a�7 z
Phone Number: ���, �32
Email Address:
certify that I have authorized h f .dJ5 'f- Gil Ci ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all.CAMA permits
necessary for the following proposed development, t//X'--
at my grope located at
in County.
I furthermore certify that 1 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
Print or Type Name
Title

i
Name or Permit Holder
Vendor
Check McMv
Chalk
warrant
%rmMtMwnOv1COmmemB
Receipt or Rerund/Reelloeared
n7
Colu-4
Columns
COMwA
CakernT
Colurrne
Column9
Inc.
Altamar
PNC Banc NA
37120
$ 100.00
transfer 046- 2, from Allmmar to C T Real PropeRFL-LC
Wdmkow NHC
PA
St James Plantation HOA
Fkst Natbnal Bank of PA
6206
S 100.00
minor mod 051-14 St James Plantation BrCp
Tnna
ciatea Inc.
Matt and Monica Bennett
FCB
16528
S 100.00
minor fee 141 Atkinson Rd Surf City PnCo
JD rot 10238
same
Stab CU
2009
3 100.00
1 minor fee 438 N Anderson Btvd, Topsail Baadr PnCo
JD rot 10240
Nellsvills,Inc.
Tim Jackson
FCB
5328
632.00
1 NOV *2045D/Permit $25alPenatty 11350Anve SU
TmaC rct. lot1IM
;r.
same
BUT
12530
S 100.00
1 Major Renewal Fee 017-09 100 Ckde Dr Ham stead PnCo
JD rcL 10237
cution
John Keene
Coastal Bank and Tent
3288
400.00
GP #74817D
JD fcL 10839
uction Inc.
Jeff and Leslie Benson
Coaabl Bank and Trust
3265,
S 800.00
GP #748160
JD rat 10641
Ohio Arent
BUT
5328
200.00
GP 976521 D
BB rat 10206
same
BUT
29818
200.00
GP t78515D
BB rot. 10205
same
Wells Fargo
3008
200.00
GP l78111 D
58 rcL 10205
Mawsly
First Bank
10798
$ 200.00
GP #7854513
88 feL 10207
;Bank of AmenAmencA
354134#78533