74816D - Benson

F�l

—Bep -
t 'j or 1,
Name of Property Owner Requesting Permit:
Mailing Address: -71 1 —P)
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development
at my property located at 5g lV On Fc,6n .
in County.
I furthermore certify that I 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 ®wnep Information:
Signature
Print or Type Name
4e A 1�2� 0
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to property C �r Aoclfr ,� of Property Owner)
ro located at �
(Address, Lo lock, Roa
on _ I �T�jC� l iC,llrlfK , in �;6Q ( GP C- , N.C.
(Waterbody) I (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 fill in description below or attach a site drawing)
t
N
L1
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
minim distance of 15' from my area of riparian access unless waived by me. (if you wish to wai%
the etb ck, 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.
Tc
wner Information)
�
Print or TVD61 NNarn
(Adjacent P/r�operty Ow er Information)
/ `��G
sign��/x1/�9'
Print or TyZ pie

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that i own property adjacent to
property l9cated at
4(D N
(L,4. � 3 . C. s
(NLnQ of Prope "Cl)
1'1 ) < I v
(Address, Lot, �ock,�gad, etc.)
on 1( '� I 6�' , in �5. , N.C.
(Waterbody) I(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatior
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)
t
E-- t 2
U U
10
a,,�5 Vb-ea- ck!�;, i,-etc(
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bac
minimum distance of 15' from my area of riparian access unless waived by me. (if you wish to wz
the setbac , you must initial the appropriate blank below.)
&/9;�to wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
Ae
Owner Information) (Adjacent Property O er #ormation)
—13Si aiure
Print or T e Nam Prior Typ Name

TOPSAIL SOUND
1.4
\
p .
o�31
Noob.
<

Nerve or Permit Helder
V-der
Check Number
Check
Dort
Penn/f NumbrlComr—ft
Receipt or ReendMeaaocafed
n7
CO(U-4
cakinaw
Co1umr6
C kinar7
Columns
Column9
Inc.
Altamar
PNC Bank NA
37120
6208
6528
2009
$ 100.00
transfer M46- , from Ahemar to CMT Real Property, LL
Wflinington NHC
PA
St James Plantation HOA
_
First National Bank of PA
$ 100.00
minor mod 061-14 St James Plantation BrCp _
Tmoc
ciates Inc.
Mari and Monica Senne6
same
FCB
S 100.00
minor fee 141 Atkinson Rd, Surf City PnCo
minor fee 438 N Anderson Blvd, Topsail Beach PnCo
JD rat. 10238
State Employees CU
S 100.00
JD rt. 10240
vile Inc.
r.
_
Tim Jackson
same
IJohn Keene
Jeff and Leslie Benson
WillieArant
same
same
Mowery
FCB
5328
$ 632.00
NOV 020-05DIPennit $250HPenalty $350/Investigative $32
Major Renewal Fee •17-09 100 Circle Dr, Hampstead PnCo
GP 074817D
GP N74816D
GP#76521D
GP t76515D
GP•76111D
GP 1176545D -
P • 8533D
Tmac rot. 10992
BBBT
$ 100.00
JD rct 10237
==ion
Hcbon Inc.
Coastal Bank and Trust
3266
629810
400.00
JD rct. 10839
Coastal Bank and Trust
3265
600.00
JO rcl. 10841
BBBT
5328
$ 200.00
BBrc1.10208
BB&T
200.00
BB rct. 10206
Wells Fa
30D8
i 200.00
BS rct. 10205
First Bank
0798
200.00
BB' 10207
same ____
Ban of America
3841
.00
PA rcL 7 7