77826D - Mattox

CAMA/ ❑DREDGE & FILL N° 77826 A B
3ENERAL PERMIT Previous permit#
]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
•ized by the State of North Carolina,Department of Environmental Quality
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 0 14 t 1•100
❑Rules attached.
t Name ' l4. M R it 0 X Project Location: County N De A--- C�
2
t5 2 N O+-4'�`. 1r2o PI? Street Address/State Road/Lot#(s)
c'Yt I `' P ) State t' - ZIP 2‘(4A3 Li P`-OA
6 10)5 4 R 116 z E-Mail Subdivision
ed Agent 17P`v I D l O rA►J City )-4144(51-litct ZIP ir'
❑CW 24EW [ PTA ❑ES ❑PTS Phone# ( ) ' 1 'River Basin IN • C
❑❑OEA HHF ❑IH ❑UBA ❑WA Adj.Wtr. Body (VA 1t-t- , nVV J€ alF;or
❑ PWS: Closest Maj.Wtr. Body -IO P511A 1(--- Sty J F4 I;
yes 6 PNA yes
Project/Activity 1 IQ ST A LA-- VI 4t- 1►..) DO G[G/A)6- FA- —.
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ig permit may be required by: ❑See note on back regarding River Basin ri
_ocal Planning Jurisdiction) i , /+ ' .

AUG 18
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: (1 k4J A(k V (I
Mailing Address: S 27, \(�\An-{
Phone Number: c 0 -- L{l — l �Z--
Email Address: (�� t�1 "C'E K�(t1 t ( � L6V.n
I certify that I have authorized David Logan of Logan Marine, LLC
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 c2 3 t rh i LaJ-E 1 a_ (\
in 5>,("-►.-1C-�(Z._ 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 Owner Information:
.4R
brSiature
ftyCiYv J nhtray
Print or Type Name
Owner
Title

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3. A. Signature �1
r t r 0 Agent
• Print your name and address on the reverse X��i 7 lit -- 1/ ' ��-Addrossee
so that we can return the card to you. B. Received by(Printed Name) DateDelivery
• Attach this card to the back of the mailpiece, 1 .
of
or on the front if space permits. t
1. Article Addressed to: D. Is delivery address different from Item 1? • Y.s
If YES,enter delivery address below: ❑ No
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❑Adult Signature 0 Priority
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❑Adult Signature Restricted Delivery ❑Registered Mail Restricted
❑Certified Mail® Delivery
9590 9402 2978 7094 5966 66 o Certified Mail Restricted Delivery 0 Return Receipt for
❑Collect on Delivery Merchandise
0 Collect on Delivery Restricted Delivery ❑Signature Confirmation''
2. Article Number(Transfer from service label) Insured Mail 0 Signature Confirmation
7 018 1130 0002 0001 7728 In over sured
Mail Restricted Delivery Restricted Delivery
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PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
U.S.RTIFIED MAIL® RECEIPT
co p mestic Marl Only
ft-i visit our website at www•usps com`'•
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Total Postage and Fees
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PS Form 00,April 20 t5 PSN 7530 02

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Ryan Mattox ,s
(Name of Property Owner)
property located at 523 Hughes Rd. Hampstead. NC 28443 LT 91 PB 12/1 Washington Acres
(Address, Lot, Block, Road, etc.)
On Mill Creek , in Hampstead.Pender County , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. .
have no objection to this proposal.
(J 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)
PLOT PLAN ATTACHED
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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' setback I requirement.
7g,.l do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent PropertyOwner Information)
Ar-,,rni_
5z
Signature Signature
Ryan Mattox William Mattox
Print or Type Name Print or Type Name
523 Hughes Road Lot 90 PB 12/1 Washington Acres
Mailing Address Mailing Address
Hampstead,NC 28443 Hampstead,NC 28443
rl►v/Rfarcn;.,

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EDGE OF MARSH
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RICHARD CAVENAUGH �, ,,
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QUARTER DISTANCE _— G ^a
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Chock
o(MYn4 Nemo of Permit Ndd., Vendor Chock Number amount \ Permit Numbor/Commecte Receipt or Retund/Roalklcatad
W Column4 Column6 Column!! Column? Column8 Colomn9 _
same BB&T 4480 $200.00 GP#77616D Ben rct.10295
Calvin LaFrance Coastal Bank and Trust 3284 $200.00 GP#77827D JD rct.11632
Ryan Mattox BB&T 7096 $200.00 IGP#77826D JD rct.11631

•
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
Signature
• Complete items 1,2,and 3. A. ✓ ❑Agent
• Print your name and address on the reverse X f_A j'.i IP,; -. . ) ..,0 / I. f•B„q44dressee
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
B. Received by(Printed Name) Date of delivery
��, �
or on the front if space permits. y t
1. Article Addressed to: D. Is delivery address different from item 1? ■ Y,s
If YES,enter delivery address below: ❑ No
TI&ORD 61/A-AIA-U4;t4"
.525 1-f)6iik-s D
DAMPS i�A�) /dG224 .
11111111111111111111 I III I I I I I I 3. Service Type 0 Priorityei Mail Express®
❑Adult Signature 0 Registered l Expr
❑Adult Signature Restricted Delivery ❑Registered Mail Restricted
❑Certified Mail® Delivery
9590 9402 2978 7094 5966 66 ❑Certified Mail Restricted Delivery 0 Return
Receipt for
0 Collect on Delivery
❑Collect on Delivery Restricted Delivery Signature Confirmationmi
2. Article Number(Transfer from service label) Insured Mail 0 Signature Confirmation
7018 1130 0002 0001 7728
Insured Mail Restricted Delivery
(overesoo) Restricted Delivery
• PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
U.S. Postal Service' ,
CERTIFIED MAIL® RECEIPT
<I Domestic Mail Only
f`- For delivery information,visit our website at www.usps.com".
Hatost qui I°1 4
ml
O Certified Mail Fee
co $3.55 � 0480
$
rziExtra Services&Fees(check box,add fee at prfe�p1-M,ate) 42
❑Return Receipt(hardcopy) $ $0..00 �\
a ❑Return Receipt(electronic) $ $I �I� Postmark �`,t
O ❑Certeied Mail Restdcted Delivery $ 4 0.00 Here �'
0 Adult Signature Required $ $0.00 /%C7
Adult Signature Restricted Delivery$
&1/4.4(2
1=1 Postage
rri $l l.55
r-B $ 08/12/2020
Total Postage and Fees
$ $6.95
co rrR Sent To r I„ /lo_ ) e_ u l 5 /.
1� Street and Apt.No.,or Pb Box C�GW ;� �iL
2 g t45 .e
Cary State,ZIP•i- D Z . 3
AL b i -i_ I
PS Form 3800,April 2015 PSN 7530-02-00o-9047 See Reverse for Instructions