56657D - Mast

CAMA / ❑ DREDGE & FILL
iENERAL PERMIT Previous permit #
slew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources f� Z OG�
�astal Respurces Commission in an area of environmental concern pursuant to 15A NCAC ��/ L�R'ules attached.
Name ? i % Project Location: County ,dQ SA✓" C
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ling permit may be required by: if�lC P.9.. 7 f 2 P �0� �n ❑ See note on back regarding River Basin

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US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
lame of Property Owner:
kddress of Property:
kpplicant's phone #
Peggy S. Mast
26 Monroe Street, Ocean Isle Beach, NC Brunswick Cc
(Lot or Street #, Street or Road, City & County) _
919-649-4198
Mailing Address: 550 Deepwood Drive
Henderson, NC 27536
hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
ias described to me as shown on the attached drawing the development they are proposing. A description of drawing,
Nith dimensions, must be provided with this letter.
l" 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 obiection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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' set back requirement.
_ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Peggy S. Mast
Print or Type Name Wc),,
550 Deegw4+d Drive
Mailing Address
Henderson, NC 27536
(Riparian Property Owner Information)
?
Signature -�-
Print or Type Name
331y ;3yzNsm—\- �Zvirq
Mailing Address
VM+ATlC0O

MD DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Peggy S . Mast is
(Name of Property Owner)
property located at 26 Monroe Street
(Lot, Block, Road, etc.)
on canal in Ocean Ilse Beach , N.C.
(Waterbody) (Town and/or County)
550 Deepwood Drive
Applicant's phone #: 91 9 — 6 4 9 —41 9 8 Mailing Address:
Henderson, NC 27536
Fle 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/inooring pilings / boatlift ! boathouse
must be set 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.)
Jr1��Cdonot 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)
------------- •-------------..-----------------------------
(Information for Property Owner Applying
for Permit)
550 Deepwood Drive
Mailing Address
Henderson, NC 27536
-------------------------------------------------------
(Riparian Property Owner Information)
C
Si ure
� 4 A) /�'l c 8A1 nJ_ Ems/

.wrr�rr.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3everly Eaves Perdue James H. Gregson
governor Director
Dee Freema
Secretar
AGENT AUTHORIZATION FORM
Date: `i✓ d
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Peggy S. Mast
wner's Mailing Address:
550 Deepwood Dr,
Henderson, NC 27536
hone Number (919) 6 4 9 -41 9 8
William McRainey
Agent's Mailing Address:
1462 Village Point RD SW
Shallotte, NC 28470_
Phone Number( 91 4t 471 -6892
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
Replace 8' x 40' floatinq dock
my property located) at 26 Monroe Street, Ocean Ts1 P RPar-ham nT�
This certification is valid thru (date) July 10, 2011
r rty Owner Signature Date

ilicant: y fl' y
Permit #: 5 ,�� 7•- ,j�
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
id in your Habitat code sheet.
itat 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 incfudes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fine
disturbance.
Excludes any
restoration and/
temp impact
amount)
ZJ
Dredge ❑ Fill ❑ Both ❑ Other
-2G
32 G
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 ❑ Filf ❑ Both ❑ Other ❑
Dredge ❑ Fill 0 Both 0 Other ❑

7327
cRainey
60 66-1215/531
at Rd. S.W. % 7 r 830
'470 --- - Date
/10
i' -r Dollars a
OMAW
2 15 21:130000 9 2 3001180 ? 3 2?