53958D - Brackin

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
C.New Modification Complete Reissue . Partial Reissue Date previous permit issued
iorized by the State of North Carolina, Department of Environment and Natural Resources _ ,/
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Zn• /ZQG
n CI'RGfes attached.
int Name P I r'/� ` /,/ 2� /C'i •f Project Location: County �R u.rS�✓i c/L
is Ty 5 .S6 fZCv,7x Le,✓ e Street Address/ State Road/ Lot #(s) ,3/3 0,,,vTP
Stated ZIP 1 6 z �i✓�r,i
# O • 3267 Fax # O Subdivision Dle,4 tS A e
-ized Agent
:d ❑ CW
❑ OEA
r
❑ PWS:
yes / no
QEW C3-PTA ❑PES ❑ PTS
❑ HHF ❑ IH ❑ UBA N/A
❑ FC:
PNA yes /(f� Crit.Hab. yes / no
City*"'ido 9'0' zip 28y
Phone # ( ) River Basin 24-01.1rG
Adj. Wtr. Body "41t lAH/ nat
Closest Mal. Wtr. Body /G✓h/
of Project/ Activity ,. t ' ,ft.' 7'e A l .c_ AOC eC %'21 1
Jock)length ,0 4
rm(s)_ /b X1 %Z
pier(s)
length
lumber
aad/ Riprap length
wg distance offshore
nax distance offshore
channel
:ubic yards
amp
Bulldozing
La9>< /
..........
ine Length ` Q
not sure yes
no .k
ags: not sure yes
no a
orium: n/a yes
Co
s: yes
r Attached: yes
Pno-,,3-
(Scale:
ding permit maybe required by: L�p,.�/� See note on back regarding River Basin

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHO USE)
I hereby certify that 1 own property adjacent to �/e'/��2D 1�Yc2 C,�'t /y 's
// (Name of Property Owner) /� /-/ p
property located at �4 %� �� 313 � 109111--140/ !� 1ft f lt2l tB0 ,91,
/ (Lot, Block, Road, etc.)
on Q �'OCP j7� ( (Llgi , in a'KQyl. S ("1(' C � , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: /ID 3� 7 Mailing Address: 3 T 5e—
Zk idti/ /3Pa d-1
fie 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 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 trust initial the appropriate blank
below.)
/.) I do not wish to waive
I do wish to waive that setback requirement.
---------- 7----------- 7---------- 7-------------- 7-------- 7-------- -------- ------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
r�
Mailing Address — Signature
41dena0
City/State/Zip Print or Type Name

09/12/2009 10:42 7044829427 ME MCCRACKEN
Sup 12 09 M 21a richard C brackin, jr 910-842-3267
PAGE 01/01
gonl,D bt4avEi4.
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PM AIMOOMNG PHJNGS/,8I,IOATT180ATBOUSE)
I hereby certify that I own property Adjacent to h/Lt/ n /; C,IC/2' 's
(Name of property Owner)
property located at � ' u�� �� S �G'K'p � LL�� � /7,�AC`k'� %3 a c
(Lot, Block, Road, etc.)
on LN�L6La)61-4u 1 U.'CL-i4f✓, in N.C.
(Waterbody) y (Town sad/or County) /
Applicant's phone 11: qlO ,, V��oZ1C`/ Muiline Address: 3c%_5-,JeV,''n • t 1-4,q e-
eci c e a,
fie has described to me, as shown below, the development he is proposing at that location, and, I
have no objecdons to his proposal. I understand that a pier/mooring pilings / boetlifi / boathouse
must be set back a minimum distance of fifteen feet (19) from my arcs 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 dS wish to waive that setback requirement,
^ ..N
DESCRIPTION AND/OR DRAWING OF'rROPOSED DEVELOPMENT:
(To be JMed in by i'ndividudl proposing dew4opntenr)
(Information for Property Owner Applying _ (Riparian Property;0 er 1 o
for Permit)
Mailin
g Address '- / Si ature
e/`I^ �- %�ny1�C'/,a,,,,e�LjK-ni
c� �_ 1/� /UNL sS .COAL ,In; c2p-.4S:�.Cii
City/State%zip �7 Print or Type Name
Tey�1,,q#)One Number I
¢ -z 174,11-f'73-73¢-` C62�
�.� Tql phone Number
Simnature nor..

•..+.-0
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freem
Governor Director Secret
AGENT AUTHORIZATION FORM
Date: —d 9
Name of Property Owner Applying for Permit:
A cQhisd o6e�,42,nl
Mailing Address:
3�� S•e�Pery��y, L�sye
tib,l�Q,� &dah Al,0,
Phone Number: (9/0 fy�
... .. .. r... _.. ..... .... _Y. __... .
I certify that I have authorized (agent) )etc iso.d. f3gen1,� _ to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
construct (activity) L,',D,ysMadf ldM� -r- l f,' , A.- eW.Dan ++ B 4--aia
at (my property located at) 3i3 6 4,AJds&&47✓ 4J.4y r�/4� A Nle.41
This certification is valid thru (date) /- /-/6
L./G -as 9
Prnnartv r)wnar Sinnature
Data

DOUBLE D CHARTER SERVICE LLC 1035
345 Serenity Lane W112/531
Holden Beach, NC 28462 a Q BRANCH 62101
Ph. 910-842-3267 DATE -/ -17-6 /
THE
ROB/��
lot
Dp DOLLARS �•.
BRANCH BANKING COMPANY
1-000-MMK BUT BBanAT.wm r J rv/ i•�
NP
11'0000 1035il' 1:053 LO i i 2 P:0005 295 29958611•