56668D - Benson

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
overly Eaves Perdue James H. Gregson
overnor Director
AGENT AUTHORIZATION FORM
Date: ' , ( " l I
ame of Propertygwner Ap lying for Permit
wner's Mailing Address:
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hone Number
Dee Freemai
Secretar
Name of Authorized Agent for this project:
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Agent's Mailing Address:
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Phone Number (110 ) 21 Z —11C 9 Q fib
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at 0 ) � i t-'1 r1 o 91 1]
This certification is valid thru (date) ' I pkj�— I . a o ) I
Prop y her Signature
Date

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER 3,100RIXG PILI_VGS/BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to B 0-+A5 o A
(Name of Property' Owner)
property located at .Z/ 2 5,inw-�ons Dl .
(Lot, Block, Road, etc.)
on �.�..W ,in e s\NM 49eJe/' m.�� ,N.(
(Waterbody) (Town and/or Coun )
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be se
back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
----------------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in w
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington,
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
(Information for Property Owner/Applicant
Applying for permit)
Mailing Address
(Riparian Property Owner Information)
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TRI-INLET MARINA LLC
DBA SCOTTS HILL MARINA
2570 SCOTTS HILL LOOP ROAD
WILMINGTON, NC 28411
910-686-0896
RE: BRAD BENSON PROPERTY PIER
212 SIMMONS DR.
WILMINGTON, NC 28411
TO WHOM IT MAY CONCERN,
BASED UPON THE PLAN DRAWING SUBMITTED TOME I WOULD LIKE TO CLARIFY THE
100' SETBACK IS MEASURED FROM THE NORTHEN MOST POINT OF OUR FLOATING DOCK
THAT IS PARRALLEL TO THE INTERCOASTAL WATERWAY. IF THE 100' DISTANCE IS
MEASURED FROM THIS NORTHERN MOST POINT I ESTELLE BRADSHAW OWNER OF
SCOTTS HILL MARINA LOCATED AT 2570 SCOTTS HILL LOOP ROAD HAVE NO OBJECTIONS
TO THE PROPESD PIER PLANS AT 212 SIMMONS DR.
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DATE
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MAR 0 4 2011

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER4100RLVG PILINGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to traA Se„J6h
(dame of Property Owner)
property located at `Z 1 Z S i � I, ",, � r .
(Lot, Block, Road, etc. \
on � . C - W , , in 5; C '11 �i'c Kale. Cam.., r V1 , N.(
(titi aterbody) (Town and/or County
He has described to me, as shown below, the development he is proposing at that location, and, I have
no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be se
back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
--------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in w
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, i
DCM representatives can also be contacted at [phone].
No response is considered the same as no obiection if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
Mailing Address
(Riparian Property Owner Information)
S ignatui
Citv/State/ZiD

IC Division of Coastal N19t, Habitat Impact Computer Sleet
)plicant:
ate: ,
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ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
ibitat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount
n
Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
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Dredge [I Fill [I Both El Other ❑
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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 ❑
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66-85/531
AMES W. JONES, JR.
ONNA M. JONES
522 DEAN DR. pH. 910-3954999
yak
NGTON, NC 28405 $
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RBC Bank'
RBC B.* (USA)
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